肺康复训练结合早期心脏康复护理对老年慢阻肺缓解期伴慢性心衰患者的影响研究

研究在老年慢阻肺缓解期合并慢性心衰患者群体的治疗过程中应用肺康复训练与早期心脏康复护理的实际意义。方法 本次研究的所有参与者均来自于我院接收的慢阻肺缓解期合并慢性心衰患者群体,样本抽取起始时间为2022年3月,截止时间为2023年12月,共计抽取的患者人数为48例,将这些患者通过电脑分组分为2组,其中应用常规护理方法的24例患者认定为对照组,应用肺康复训练结合早期心脏康复护理的患者认定为研究组,分析在老年慢阻肺缓解期合并慢性心衰患者群体的治疗过程中应用肺康复训练与早期心脏康复护理的实际意义。结果 研究组的患者在实施了肺康复训练结合早期心脏康复护理后心功能指标比对照组更好(P<0.05)。研究组的患者在实施了肺康复训练结合早期心脏康复护理后肺功能指标比对照组更好(P<0.05)。研究组的患者在实施了肺康复训练结合早期心脏康复护理后护理满意度比对照组更好(P<0.05)。结论 针对老年慢阻肺缓解期合并慢性心衰患者的治疗过程中配合肺康复训练与早期心脏康复护理能够有效改善患者的治疗效果,值得推广。

体位指导联合呼吸康复对慢阻肺稳定期并心衰预后的影响

目的 讨论体位指导干预联合呼吸康复训练对慢阻肺稳定期并心衰患者的心功能、肺功能及效果分析。方法 入选50例慢阻肺稳定期并心衰患者主要于2021年5月至2022年10月参与本次试验,依据随机数字表法分组,即对照组与研究组,各25例。对照组实施常规护理,研究组在对照组基础上实施体位指导干预联合呼吸康复训练,而后分别在护理前及护理1个月后观察患者心功能及肺功能。结果 心功能指标护理前研究组与对照组差异无统计学意义(P>0.05);该指标护理1个月后研究组改善程度比对照组更加理想,差异有统计学意义(P<0.05)。肺功能指标护理前研究组与对照组差异无统计学意义(P>0.05);该指标护理1个月后研究组改善程度比对照组更加理想,差异有统计学意义(P<0.05)。结论 慢阻肺稳定期并心衰患者实施体位指导干预联合呼吸康复训练利于促进心功能及肺功能恢复,护理价值十分理想。

胺碘酮治疗老年慢性心衰合并心律失常的效果观察

目的探讨胺碘酮治疗老年慢性心力衰竭(心衰)合并心律失常效果。方法70例老年慢性心衰合并心律失常患者,随机分为观察组与对照组,各35例。对照组给予常规抗心衰治疗,观察组给予常规抗心衰治疗联合胺碘酮治疗。比较两组临床效果、心功能相关指标、临床相关指标、不良反应发生情况。结果观察组治疗总有效率97.1%高于对照组的74.3%,差异有统计学意义(P<0.05)。治疗后,观察组左心室收缩末期内径、左心室舒张末期内径、左心室射血分数、心率及校正QT离散度(QTc)均优于对照组,差异有统计学意义(P<0.05)。观察组心衰缓解时间、总住院时间、心律失常消失时间分别为(54.11±2.21)min、(6.57±2.26)d、(4.56±0.21)d,均短于对照组的(78.21±6.21)min、(8.44±2.62)d、(5.12±0.21)d,差异有统计学意义(P<0.05)。观察组不良反应发生率2.86%低于对照组的22.86%,差异有统计学意义(P<0.05)。结论老年慢性心衰合并心律失常患者实施给予常规抗心衰治疗联合胺碘酮治疗效果确切。

小剂量倍他乐克联合地高辛治疗慢性充血性心力衰竭伴快室率房颤46例临床观察

目的探讨小剂量β受体阻滞剂倍他乐克联用地高辛治疗慢性充血性心力衰竭(简称慢心衰)合并快室率房颤的疗效与安全性。方法分析慢心衰合并快室率房颤患者加用小剂量β受体阻滞剂倍他乐克前后心功能、心率变化及不良反应。结果治疗组心率、心功能改善率与对照组有明显差异(P<0.05),不良反应有心动过缓和低血压。结论小剂量倍他乐克联合地高辛治疗慢心衰并快室率房颤安全有效。

养心合剂对慢性心力衰竭利尿剂抵抗病人AVP、AQP2表达的影响

目的观察养心合剂对慢性心力衰竭利尿剂抵抗病人血管加压素(AVP)、水通道蛋白-2(AQP2)表达的影响。方法选取慢性心力衰竭利尿剂抵抗病人60例,随机分为试验组与对照组。对照组给予西医标准化治疗,试验组给予西医标准化治疗加服养心合剂,连续治疗10d后比较两组AVP、AQP2浓度、24h尿量,观察不良反应。结果治疗后试验组血浆AVP及尿液AQP2浓度均较治疗前下降(P <0.05),且低于对照组(P <0.05);治疗后试验组24h尿量较治疗前增加,且优于对照组(P <0.05);养心合剂安全性良好。结论养心合剂可能通过抑制AVP、AQP2的表达,减轻水钠潴留及利尿剂抵抗,进而改善病人心功能,延缓心力衰竭的发展。

美托洛尔对慢阻肺肺心病心衰患者RHR、PASP、RV的影响

目的探讨美托洛尔对慢阻肺肺心病心衰患者RHR、PASP、RV的影响。方法选取98例2013年4月~2015年12月在我院接受治疗的COPD肺心病心衰病人,采用随机方式将这些病患分为对照组（48例）与观察组（50例）,对对照组实施常规治疗,对观察组加用美托洛尔治疗,认真观察两组患者的心力衰竭症状,并详细记录患者的RV、心率及PASP,并观察与对比治疗前后两组患者的Sa O2、Pa CO2、LVEF、Pa O2、LVEDD以及LVESD等指标。结果观察组患者治疗的总有效率94.0%（47/50）明显比对照组72.9%（35/50）高（P〈0.05）,Pa O2、Sa O2、LVEF水平均明显比对照组高（P〈0.05）,Pa CO2、LVESD、LVEDD及RHR、PASP、RV水平均明显比对照组低（P〈0.05）;观察组和对照组患者的不良反应发生率6.0%（3/50）、8.3%（4/48）之前的差异不显著（P〉0.05）。结论 COPD肺心病心衰治疗中应用美托洛尔有助于改善患者PASP、RV与RHR等指标,提升患者临床治疗有效率,从根本上改善患者超声心动指标和血气,值得临床应用与推广。

肺康复训练+早期心脏康复护理对老年慢阻肺缓解期并慢性心衰患者心肺功能的改善效果研究

研究尽早针对患者心肺功能进行康复训练及护理给合并慢性心衰且处于慢阻肺缓解期的老年病人带来的影响。方法 选定98例于2021年4月~2024年4月期间在本医院接受治疗的合并慢性心衰且处于慢阻肺缓解期的老年病人,按照“随机数字表法”均分为对照组(n=49)、实验组(n=49),前者行常规康复护理措施,后者尽早针对患者心肺功能进行康复训练及护理,检测患者心肺功能,评估其运动能力、心理状态、生活质量,统计其满意度,并将以上指标纳入组间对比。结果 实验组于干预前对运动能力、心理状态、生活质量的评估结果及对心肺功能的检测结果与对照组无明显不同,P>0.05;实验组于干预后对运动能力、生活质量的评估结果及对心功能指标LVEF、所有肺功能的检测结果均比对照组更高,对心理状态的评分结果、对LVEDV、LVEDV的检测结果则比对照组低,P<0.05。相较于对照组,实验组患者的护理满意度显著更高,P<0.05。结论 老年慢阻肺缓解期并慢性心衰患者尽早针对患者心肺功能进行康复训练及护理不仅能够对其心肺功能、生活质量、运动能力、满意度产生积极影响,并对改善心理情绪方面具有积极意义,临床深究、借鉴。

关于体位指导干预联合呼吸康复训练对慢阻肺稳定期并心衰患者心功能、肺功能及效果

探析慢阻肺稳定期合并心衰患者联合应用体位指导、呼吸康复训练的干预价值,评估对患者心肺功能产生的影响。方法 选取2022年1月到2023年2月在联勤保障部队第九〇〇医院心胸外科择期手术的慢阻肺稳定期并心衰患者,共计100例,应用随机数字表法将其分成两组。对照组纳入的50例患者实施常规护理,剩余50例将其命名为观察组,所用干预模式为体位指导干预联合呼吸康复训练,采取相应干预方案后对比两组护理效果,评估项目包含心肺功能以及呼吸困难评分(mMRC评分)。结果 对照组、观察组执行相应护理措施后心功能水平统计结果显示P<0.05。护理前,两组别肺功能水平各评估项目对比未见明显差异P>0.05,护理后,就两组肺功能水平综合评估,观察组三项评估项目测定数值均偏高于对照组,统计结果显示为P<0.05。护理前组间mMRC评分展开统计学分析,所得结果显示为P>0.05;护理实施后,观察组mMRC评分测定数值较低,和对照组之间的统计值呈现为P<0.05。结论 慢阻肺稳定期并心衰患者联合应用体位指导干预、呼吸康复训练可有效改善患者心肺功能,提升了整体护理服务质量,值得借鉴。

血清N末端脑钠素原定量检测对呼吸困难鉴别诊断的临床价值

目的:探讨心源性呼吸困难和肺源性呼吸困难以及慢阻肺合并心衰患者血清N末端脑钠素原水平检测的临床意义。方法:对25例以呼吸困难为主诉的患者进行血清NT-proBNP检测,包括心源性呼吸困难和肺源性呼吸困难以及慢阻肺合并心衰,观察三组患者血清NT-proBNP浓度。同时测定20例健康体检者的NT-proBNP水平作为对照组做比较分析。结果:三组患者的血清NT-proBNP水平中,心源性呼吸困难患者为(7 562.2±6 753.6)pg/ml,慢阻肺合并心衰患者为(3 629.2±2 403.8)pg/ml,这两组血清NT-pro BNP水平明显高于肺源性呼吸困难组(243.1±174.9)pg/ml,差异有统计学意义(P<0.05)。结论:NT-proBNP可作为鉴别心源性呼吸困难和肺源性呼吸困难的一个客观指标,其方法简单、迅速、特异性好、敏感性高、阴性预期值非常高。

SERUM CONCENTRATIONS OF HYALURONIC ACID, PROCOLLAGEN TYPE III NH_2-TERMINAL PEPTIDE, AND LAMININ IN PATIENTS WITH CHRONIC CONGESTIVE HEART FAILURE

Objective To explore the role of serum fibrotic indices including hyaluronic acid （HA）, procollagen type Ⅲ NH2-terminal peptide （PCIIIP）, and laminin （LN） in assessing the severity of myocardial fibrosis in chronic congestive heart failure （CHF）. Methods Serum levels of HA, PCIIIP, and LN in 39 patients with CHF E [14 with New York Heart Association （NYHA） functional class II, 21 with class Ⅲ, 4 with class Ⅳ] and in 46 patients with NYHA functional class I were assessed by radioimmunoassay. Results The serum concentrations of HA, PCMP, and LN were 359.75 ± 84.59 μg/L, 77.88 ± 24. 67 μg/L, 86. 73 ± 23.90 μg/L in CHF group, and 211.60 ±54. 80 μg/L, 64.82 ±23.99 μg/L, 82. 26 ±23.98 μg/L in NYHA functional class Ⅰ group, respectively. The HA level was significantly higher in CHF patients as compared with NYHA functional class Ⅰ group （ P 〈 0.05 ）. However, no difference was found in the levels of PCIIIP and LN between CHF group and NYHA functional class Ⅰ group. The serum HA concentration was negatively correlated with left ventricular ejection fraction （ r = - 0.71, P 〈 0.05 ）. Conclusion Serum HA level may act as an indicator for myocardial fibrosis.

Deteriorated function of cutaneous microcirculation in chronic congestive heart failure

Background Chronic congestive heart failure is a complex condition that leads to dysfunction in the peripheral microcirculation. We have previously shown that vascular reactivity is reduced with increasing age. In this study, we examined a group of very old patients with severe chronic heart failure to test the hypothesis that vascular function is further compromised by a combination of heart failure and aging. Methods Cutaneous forearm blood flow was measured by laser Doppler flowmetry and compared among three groups： Group 1 （n = 20, mean ±SE： 85.5 ±4 years）, heart failure patients with New York Heart Association class Ⅳ （NYHA Ⅳ） and with a NT-proBNP level ≥5000 ng/L; Group 2 （n = 15, mean ±SE： 76.5 ±2 years）, heart failure patients with NYHA II and NT-proBNP ≤2000 ng/L, and Group 3 （n = 10, mean ±SE： 67.6 ±3.0 years）, healthy controls with no clinical signs of heart failure. The vasodilator response to the iontophoretic administration of acetylcholine （ACh）, acting via an endothelial mechanism, and sodium nitroprusside （SNP）, acting via a smooth muscle cell mechanism, were studied. Results All patients with heart failure had significantly reduced vascular reactivity independent of the mode of stimulation （ACh, SNP or heat） when compared to healthy controls. However, the responses did not differ between the two groups of heart failure patients. Conclusions Cutaneous vascular reactivity is reduced in heart failure patients and does not correlate with the severity of the condition or age of patients.

Effects of Bisoprolol on the ventricular function and hemodynamics in patients with atrial fibrillation and chronic heart failure

Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing with significant morbidity and increasing mortality rates. Thus it is necessary to establish therapy to improve the poor prognosis in this high-risk population, but a specific benefit of beta-blockers to the subset with concomitant AF and CHF has been little demonstrated. Objective: To examine the effects of Bisoprolol (6 months treatment) on the ventricular function and hemodynamics in patients with AF and CHF. Methods: 84 patients with stable CHF (NYHA≤Ⅲ class) and AF were assigned to Treated Group( n = 37) or Control group Ⅰ ( n = 22, 24-hour heart mean rate < 70/min) or Control Group Ⅱ ( n = 25, 24-hour heart mean rate ≥ 70/min) . All patients were given the basic therapy for CHF, and Treated Group received Bisopolol. Clinical and echocardiographic variables were measured in 3 groups at baseline and after 6 months, and the results were compared . Results: After 6 months of treatment with Bisoprolol, left ventricular ejection fraction (LVEF) and NYHA class had significandy improved (P < 0.05), and a trend towards a reduction in combined end point of death or CHF hospitalization was also observed (P < 0.20) in Treated Group; The increase of LVEF in Treated Group were associated with a reduction in mitral regurgitation degree and left atrial volume; The heart rate in mean 24-hour and at peak exercise decreased in Treated Group, but were similar to that in Control Group Ⅰ. Conclusion: 6 months of Bisoprolol therapy resulted in an improvement in the NYHA class and LVEF, and also showed a trend towards a reduction in hospitalization or death. The beneficial effects of Bisoprolol on patients with AF and CHF may be partly mediated by improvement of ventricular diastolic function.

Meta-analysis for efficacy of modified Zhenwu Decoction combined with westernmedicine in treatment of heart failure

Objective： To carry out a systematic evaluation of the efficacy of modified Zhenwu Decoction combined withwestern medicine in the treatment of heart failure. Methods： Literature was retrieved in China KnowledgeResource Integrated Database （CNKI）, Chinese scientific journal database （VIP）, Wanfang Data Resource System（WANFANG DATA）, PubMed and other traditional Chinese medicine related periodicals by retrieval methods ofsubject terms combined with free words and computer retrieval combined with manual retrieval. Literature wasscreened strictly according to the inclusion criteria.The quality of the included literature was evaluated according tothe quality standard of Jadad scale and Cochrane collaboration network bias risk assessment tool. The literaturedata was extracted. RevMan5.3 software was used to analyze data and the curative effect of modified ZhenwuDecoction combined with western medicine was objectively evaluated. Results： The response rate of theexperimental group was better than that of the control group [OR = 3.69,95% IC （2.36,5.79）]. The value of EF inthe experimental group was higher than that in the control group after treatment [MD = 5.85, 95% IC （3.90, 7.79） ].The Lee, score of the experimental group was lower than that of the control group after treatment [MD = -1.37,95% IC （-2.23, -0.52） ]. The value of BNP in the experimental group was less than that in the control group aftertreatment [MD = -114.48, 95%IC （-186.28, -42.68）]. The life quality score in the experimental group was less thanthat of the control group after treatment [MD = -8.44, 95%IC （-11.73, -5.15）]. Conclusion： The curative effect ofmodified Zhenwu Decoction combined with western medicine in the treatment of heart failure is better than thesimple western medicine treatment.So modified Zhenwu Decoction combined with western medicine in thetreatment of heart failure is worthy of clinical promotion. However, the results of this study still need further validation by more high quality randomized double blind controlled clinical trial because the overall quality of theresearch included.

Analysis of 610 cases inpatients with chronic heart failure

Objective： To analyze the clinical characteristics and medical treatment of hospitalized patients with chronic heartfailure, and provide medication for the patients. Methods： According to medical records of inpatients, demographicinformation, etiology, clinical features and treatment information were collected. Results： A total of 610 cases withheart failure from our hospital between July 2010 and June 2016 were analyzed. The average age of all the patientswas 63. Males accounted for 50.49%. There were 82.7% patients with NYHA functional classification at III-IV.31.3% patients with coronary artery disease, 28.4% with rheumatic heart diseases and 21.8% with expansion ofheart disease. 27.4 percent of the patients with the left ventricular ejection fraction lower than 40%. There were78.9% patients received aldosterone antagonist treatment, 63.4% received ACEI/ARB, 62.1% received digoxin,59.8% received beta blockers, and 75.4% patients received decoction, and 80.8% received Chinese patent medicine.Conclusion： The study has shown that high utilization of traditional Chinese medicine is to highlight theadvantages of the combination of traditional Chinese and western medicine in the treatment of heart failure. Theusage of spironolactone, ACEI/ARB, beta blockers in our hospital was lower than the ratio reported, higher thanthat of the national average. However, the use of diureticis is lower than that of national average, which may relateto the use of damp-clearing herbs. Clinicians should pay attention to the high utilization rate of digoxin. Patientswith the left ventricular ejection fraction 〉 50% accounted for 61.1%, which required more attention should be paidto the diagnosis and treatment of patients with heart failure of the ejection fraction remains.

Self-care among older Chinese people with chronic heart failure： the roles of cognitive and psychosocial characteristics

Chronic heart failure （CHF） is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of acute disease decompensation.High prevalence of hospital admission has been reported.[2] However, around 40% of hospital admissions was avoidable if patients demonstrate consistent self-care.

Urinary excretion of aquaporin-2 water channel protein in chronic heart failure rats

Objective To study the urinary excretion of aquaporin-2 (AQP2) water channel protein, and the relationship between urine AQP2 concentration and renal AQP2 gene expression in chronic heart failure (CHF) rats. Methods Male Sprague-Dawley rats (200?g-250?g) underwent either a left coronary artery ligation, a model of CHF, or a sham-operation. Nine weeks after surgery, urinary AQP2 concentrations and renal AQP2 protein levels were measured by Western blot. Results The urinary concentration of AQP2 water channel protein increased significantly in CHF rats as compared with sham-operated rats (365.6%±102.9% vs 98.5%±47.6%, P<0.01). There was positive correlation between urinary AQP2 concentration and renal AQP2 protein expression (r=0.89, P<0.01). Conclusion The urinary concentration of AQP2 water channel protein increases significantly in chronic heart failure rats.

Exploring the mechanism of Fu-Zi Decoction in treatment of chronic heart failure based on network pharmacology and molecular docking technology

In the present study, we aimed to explore the mechanism of Fu-Zi Decoction in the treatment of chronic heart failure(CHF) using network pharmacology. Sym Map database was used to analyze the modern medical(MM) symptoms of various medicines. The chemical components of Fu-Zi Decoction were obtained through TCMSP, ETCM database, and previous results. The targets of Fu-Zi Decoction were obtained through STITCH, Swiss Target Prediction, Target NET database, and literature. The targets for the treatment of CHF were obtained from the Dis Ge NET, GEO, and Drug Bank databases, and the common parts of the Fu-Zi Decoction targets were screened out to construct the PPI network. The PPI network was decomposed modularly, its functions were analyzed, and the KEGG pathway enrichment analysis was performed. The key target was verified by Swiss Dock for molecular docking. A total of 205 chemical components of Fu-Zi Decoction, 551 drug targets, and 521 disease targets were collected. Functional enrichment analysis revealed that it was mainly involved in biological processes, such as negative regulation of cell death, oxidative stress, and G protein-coupled receptor regulation. KEGG enrichment findings mainly involved fluid shear stress and atherosclerosis, IL-17 signaling pathway, and so on. The results of molecular docking showed that benzoylaconitine, aconitine, mesaconitine, paeoniflorin, and atractylodes Ⅲ all had a strong affinity with the core target CXCL8, suggesting that Fu-Zi Decoction could negatively regulate cell apoptosis and oxidative stress through fluid shear stress and atherosclerosis, IL-17 signaling pathway, and so on. Collectively, our data showed that Fu-Zi Decoction had a good effect on the treatment of CHF.

Effect of Lingguizhugan decoction on myocardial Nuclear factor kappa B protein expression in rats with chronic heart failure

OBJECTIVE: To investigate the effect of Lingguizhugan decoction (LGZGD) on changes of cardiac structure and function, and its putative mechanism of action, by investigating mRNA and protein expression of myocardial nuclear factor kappa B(NF-κB), and the plasma content of NF-κB in rats with chronic heart failure.METHODS: The chronic heart failure (CHF) model in rats was induced by coronary artery ligation.Sham operation was performed in control rats. Six weeks after the procedure, rats were randomly classified into the various treatment groups: model CHF, Captopril (4.4 mg/kg), low LGZGD dose (2.1 g/kg), medium LGZGD dose (4.2 g/kg), and high LG-ZGD dose (8.4 g/kg). Treatments continued for 4 consecutive weeks. Changes of hemodynamic indices were observed by the PowerLab data acquisition and analysis system. Morphological changes of myocardium were observed by hematoxylin and eosin staining, and Masson staining. The mRNA and protein expression of myocardial NF-κB were detected by reverse transcription-polymerase chain reaction and western blotting, respectively. The plasma content of NF-κB was detected by enzyme-linked immuno-sorbent assay.RESULTS: CHF rats showed significant dysfunction in hemodynamic indices and in cardiac structure.Compared with the sham operation group, mRNA expression of myocardial NF-κB and plasma content of NF-κB of the model group was significantly increased. All three doses of LGZGD, and Captopril,improved the hemodynamic dysfunction, and inhibited the change of cardiac structure while significantly improving the survival rate. Furthermore,compared with the model group, mRNA expression of myocardial NF-κB and plasma content of NF-κB were significantly reduced by all dosage groups of LGZGD as well as the\Captopril group.CONCLUSION: In CHF rats, LGZGD improves changes of cardiac structure and function via its inhibition of NF-κB.