Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

Additive Benefits of Twice Forest Bathing Trips in Elderly Patients with Chronic Heart Failure

Chronic heart failure （CHF）, a clinical syndrome resulting from the consequences of various cardiovascular diseases （CVDs）, is increasingly becoming a global cause of morbidity and mortality. We had earlier demonstrated that a 4-day forest bathing trip can provide an adjunctive therapeutic influence on patients with CHF. To further investigate the duration of the impact and the optimal frequency of forest bathing trips in patients with CHF, we recruited those subjects who had experienced the first forest bathing trip again after 4 weeks and randomly categorized them into two groups, namely, the urban control group （city） and the forest bathing group （forest）. After a second 4-day forest bathing trip, we observed a steady decline in the brain natriuretic peptide levels, a biomarker of heart failure, and an attenuated inflammatory response as well as oxidative stress. Thus, this exploratory study demonstrated the additive benefits of twice forest bathing trips in elderly patients with CHF, which could further pave the way for analyzing the effects of such interventions in CVDs.

Effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure

Objective: To discuss the effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure. Methods: A total of 100 elderly patients with chronic heart failure who were treated in the hospital between March 2014 and March 2017 were divided into control group and levosimendan group by random number table, each with 50 cases. Control group received clinical routine therapy for chronic heart failure, and levosimendan group received routine therapy combined with adjuvant levosimendan therapy. The differences in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes were compared between the two groups before and after treatment. Results: At T0, there was no statistically significant difference in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes between the two groups. At T1, serum RAAS indexes PRA, AngⅡ and ALD levels of levosimendan group were lower than those of control group;serum thyroid hormones TT3, TT4, FT3 and FT4 levels of levosimendan group were higher than those of control group;serum myocardial damage indexes cTnⅠ, H-FABP and NT-proBNP levels of levosimendan group were lower than those of control group;serum endothelial function index NO level of levosimendan group was higher than that of control group while ET-1 level was lower than that of control group. Conclusion: Adjuvant levosimendan therapy for elderly patients with chronic heart failure can effectively adjust the secretion of neuroendocrine hormones and reduce the myocardial and vascular endothelial damage.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Management of chronic heart failure in the older population

Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

Heart failure in the elderly

The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure （HF） is a condition in which the heart can not pump enough blood to meet the body＇s needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself, focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady.

Prevalence of Chronic Kidney Disease in Patients with Cardiovascular Disease

Background: Chronic kidney disease (CKD) is a worldwide public health alarming problem. Although both heart and kidneys are separated by a quite distance within the body and they perform varied functions, there is a close physiological relationship between them. The diseases in the kidneys can trigger a disease in the heart and vice versa. High blood pressure is the most significant risk factor for the development and progression of chronic kidney disease (CKD). Lowering blood pressure is a goal to prevent CKD progress. Chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing, chronic kidney disease and anemia appear to act together in a vicious circle in which each condition causes or exacerbates the other progressive chronic kidney disease. Objective: To assess the prevalence of chronic kidney disease in patients with cardiovascular disease at Shebin El-Kom Teaching Hospital and Menoufia University Hospital Cardiology Outpatient Clinic, Menoufia Governorate, Egypt. Methods: This is a cross-sectional study that was conducted in Shebin El-Kom Teaching Hospital Cardiology Outpatient Clinic, Menoufia University Cardiology Outpatient Clinic from April 2019 to July 2019. This study included 200 patients with cardiovascular disease or hypertension for more than 6 months. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, echo and abdominal ultrasound. Results: This study included 200 patients with cardiovascular disease or hypertension for more than 6 months, which showed that: 63 (31.5%) were diagnosed as chronic kidney disease, 24 (38%) known to be CKD, 39 (62%) not known diagnosed in our study. Uncontrolled hypertension, congestive heart failure, diuretics and ACEI or ARBS with diuretics together are significant risk factors for renal impairment;uncontrolled hypertension and diuretics are the most predictors for renal impairment. Conclusion: Uncontrolled hypertension is the most preventable cause of renal impairment;RAAS not cause renal impairment but lead to decreased GFR in CKD patients. We should be careful with ACEI or ARBS with diuretics or diuretics only and control congestive heart disease to avoid kidney injury and chronic cardiorenal.

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

美托洛尔、比索洛尔治疗伴高血压的慢性充血性心力衰竭的成本-效果比较

目的 比较美托洛尔、比索洛尔治疗伴高血压的慢性充血性心力衰竭(CHF)的成本-效果。方法 选取2021年12月至2022年5月该院收治的126例伴高血压的CHF患者为研究对象,按照随机数字表法分为美托洛尔组和比索洛尔组,各63例。美托洛尔组在常规药物基础上给予美托洛尔治疗,比索洛尔组在常规药物基础上给予比索洛尔治疗,30 d为1个疗程,均治疗3个疗程。对比2组治疗成本、临床疗效、不良反应,并进行成本-效果分析及敏感性分析。结果 治疗90 d,比索洛尔组和美托洛尔组的药费分别为197.46元、154.26元,比索洛尔组、美托洛尔组的平均治疗总成本分别为(4 105.47±102.48)、(4 063.52±103.61)元;比索洛尔组的疗效优于美托洛尔组,差异有统计学意义(P<0.05);2组不良反应发生率比较,差异无统计学意义(P>0.05);比索洛尔组和美托洛尔组的成本-效果比(C/E)分别为46.19、54.47,比索洛尔组的增量成本-效果比(ΔC/ΔE)为2.94;该研究将成本价格下调10%进行敏感性分析,比索洛尔组的C/E为41.57,美托洛尔组的C/E为49.02,比索洛尔组的ΔC/ΔE为2.64,敏感性分析结果与C/E分析结果一致。结论 比索洛尔治疗伴高血压的CHF临床疗效优于美托洛尔,且更具有经济性,临床可优先选择比索洛尔。

血清骨硬化蛋白、OPG、OPG/TRAIL比值对高血压伴慢性心力衰竭患者发生主要不良心血管事件的预测价值

目的探讨血清骨硬化蛋白、骨保护素(OPG)/肿瘤坏死因子相关凋亡诱导配体(TRAIL)比值对高血压伴慢性心力衰竭(CHF)患者发生主要不良心血管事件(MACE)的预测价值。方法选取2019年10月至2022年10月于该院就诊的134例高血压伴CHF患者作为研究对象,根据患者治疗1年内是否发生MACE将其分为MACE组(46例)和无MACE组(88例)。另选取同期于该院进行体检的74例健康者作为对照组。采用酶联免疫吸附实验检测3组血清骨硬化蛋白、OPG和TRAIL水平。收集所有患者的临床资料(包括冠心病史、糖尿病史、收缩压、舒张压)。检测3组血清胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6和IL-10水平。采用Pearson相关分析高血压伴CHF患者血清骨硬化蛋白、OPG和TRAIL水平与相关实验室指标水平的关系。采用多因素Logistic回归分析高血压伴CHF患者发生MACE的危险因素。绘制受试者工作特征(ROC)曲线评估血清骨硬化蛋白、OPG/TRAIL比值单独及2项指标联合检测对MACE的预测价值。结果无MACE组和MACE组血清骨硬化蛋白、OPG水平及OPG/TRAIL比值均明显高于对照组,TRAIL水平明显低于对照组,差异均有统计学意义(P<0.05)。MACE组血清骨硬化蛋白、OPG水平及OPG/TRAIL比值均明显高于无MACE组,TRAIL水平明显低于无MACE组,差异均有统计学意义(P<0.05)。MACE组TNF-α、IL-10、IL-6水平均高于无MACE组,差异均有统计学意义(P<0.05)。MACE组和无MACE组冠心病史和糖尿病史患者比例、收缩压、舒张压以及TC、TG、HDL-C、LDL-C水平比较,差异均无统计学意义(P>0.05)。高血压伴CHF患者血清骨硬化蛋白、OPG水平与TNF-α、IL-10、IL-6水平均呈正相关(P<0.05),TRAIL水平与TNF-α、IL-10、IL-6水平均呈负相关(P<0.05)。多因素Logistic回归分析结果显示,骨硬化蛋白水平升高、OPG水平升高均为高血压伴CHF患者发生MACE的危险因素(P<0.05),而TRAIL水平升高为高血压伴CHF患者发生MACE的保护因素(P<0.05)。血清骨硬化蛋白、OPG/TRAIL比值单独及2项指标联合检测预测高血压伴CHF患者发生MACE的曲线下面积(AUC)分别为0.847、0.803、0.927,且2项指标联合检测的AUC优于血清骨硬化蛋白、OPG/TRAIL比值单独检测的AUC(Z=2.350、2.824,P<0.05)。结论高血压伴CHF患者血清骨硬化蛋白、OPG/TRAIL比值联合检测患者预后发生MACE的预测价值较高。

缬沙坦、贝那普利分别联合胺碘酮治疗原发性高血压合并慢性心力衰竭的疗效对比

目的探究原发性高血压(EH)合并慢性心力衰竭(CHF)患者分别应用缬沙坦联合胺碘酮、贝那普利联合胺碘酮的治疗效果。方法选取焦作卫生医药学校附属医院2021年1月至2022年12月期间收治的90例EH合并CHF患者为研究对象,随机分为A组(n=45)和B组(n=45),A组患者应用缬沙坦联合胺碘酮治疗,B组患者应用贝那普利联合胺碘酮治疗。比较两组患者治疗前及治疗3个月后血压、心功能指标、血清炎症因子、心肌损伤指标水平;比较治疗期间两组患者药物不良反应发生率。结果治疗3个月后,两组每日晨起左侧上肢收缩压(SBP)、舒张压(DBP)水平较治疗前均明显下降,且A组低于B组,差异有统计学意义(P<0.05);治疗3个月后,两组左心室舒张末期容积(LVEDV)水平较治疗前有明显下降,左室射血分数(LVEF)均较治疗前明显增加,差异有统计学意义(P<0.05),且A组LVEF水平明显高于B组,差异有统计学意义(P<0.05),但A组、B组LVEDV水平差异无统计学意义(P>0.05);治疗3个月后,两组患者血清白介素-1(IL-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、心肌肌钙蛋白I(cTnI)、B型钠尿肽(BNP)水平均较治疗前明显下降,且A组低于B组,差异有统计学意义(P<0.05)。治疗期间两组药物不良反应发生率差异无统计学意义(P>0.05)。结论相较于贝那普利联合胺碘酮,缬沙坦联合胺碘酮治疗EH合并CHF效果突出,可进一步改善患者心功能,抑制炎性反应,恢复心肌损伤,用药安全。

冠心病慢性心力衰竭合并高血压疾病实施沙库巴曲缬沙坦钠进行治疗后的效果研究

目的分析沙库巴曲缬沙坦钠对冠状动脉粥样硬化性心脏病(简称冠心病)慢性心力衰竭合并高血压疾病的治疗效果。方法选取郓城县人民医院心内科于2021年1月—2022年12月收治的60例冠心病慢性心力衰竭并高血压患者作为研究对象,采用抽签法将患者分为两组,各30例。对照组(n=30)实施常规治疗方式,研究组(n=30)在对照组基础上增加沙库巴曲缬沙坦钠治疗。对比两组患者的心脏功能指标、血管指标及血压值,分析不良反应发生情况。结果治疗后,研究组心脏功能指标改善较对照组好,差异有统计学意义(P<0.05)。与对照组相比,研究组血管指标较优,差异有统计学意义(P<0.05)。与对照组相比,研究组血压水平更低,差异有统计学意义(P<0.05)。研究组不良反应总发生率(3.33%)低于对照组(20.00%),差异有统计学意义(χ^(2)=4.043,P<0.05)。结论实施沙库巴曲缬沙坦钠治疗冠心病慢性心力衰竭并高血压患者,经过治疗后,患者心脏功能指标、血管指标及血压值均较稳定,不良反应发生情况少,具有较好的临床效果。

同理心指导下的护理对高血压合并慢性心衰患者希望水平及生活质量的影响

目的探究同理心指导下的护理在高血压合并慢性心衰(CHF)患者中的应用效果。方法选取2020年6月至2022年6月我院86例高血压合并CHF患者为研究对象,按照入院顺序将其分为对照组(2020年6月至2021年7月)和观察组(2021年8月至2022年6月),各43例。对照组采用常规护理,观察组在对照组基础上加同理心指导下的护理。比较两组的护理效果。结果护理后,观察组的舒张压、收缩压低于对照组(P<0.05)。护理后,观察组的左室射血分数(LVEF)高于对照组,左室舒张末期内径(LVEDD)低于对照组(P<0.05)。护理后,观察组的用药总依从率为95.35%,高于对照组的69.77%(P<0.05)。护理后,观察组的Herth希望量表(HHI)评分高于对照组,明尼苏达心功能不全生命质量量表(MLHFQ)评分低于对照组(P<0.05)。观察组的病房环境、服务态度、沟通交流、日常护理、整体评价评分均高于对照组(P<0.05)。结论同理心指导下的护理在高血压合并CHF中的应用效果较好,可提高患者的用药依从性,稳定血压,促进病情好转,提高生活质量。

沙库巴曲缬沙坦钠联合常规药物治疗慢性心力衰竭合并高血压患者的效果

目的:观察沙库巴曲缬沙坦钠联合常规药物治疗慢性心力衰竭合并高血压患者的效果。方法:选取2017年3月至2022年9月该院收治的106例慢性心力衰竭合并高血压患者进行前瞻性研究,按照随机数字表法分为研究组与对照组各53例。对照组采用常规药物治疗,研究组在对照组基础上联合沙库巴曲缬沙坦钠片治疗,比较两组治疗总有效率、心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]水平、血清心肌损伤标志物[肌酸激酶同工酶(CK-MB)、肌钙蛋白、脑钠肽]水平、C反应蛋白(CRP)水平和不良反应发生率。结果:研究组治疗总有效率为96.23%,明显高于对照组的84.91%,差异有统计学意义(P<0.05);治疗后,两组LVEF水平高于治疗前,且研究组高于对照组,两组LVESD、LVEDD、CK-MB、肌钙蛋白、脑钠肽、CRP水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:沙库巴曲缬沙坦钠联合常规药物治疗慢性心力衰竭合并高血压患者可提高治疗总有效率,改善心功能指标水平,降低心肌损伤标志物水平和CRP水平,效果优于单纯常规药物治疗。

益气通络汤联合贝那普利及美托洛尔治疗老年高血压合并慢性心力衰竭患者的效果

目的分析益气通络汤联合贝那普利、美托洛尔对老年高血压合并慢性心力衰竭(CHF)患者的影响。方法选取2020年11月—2023年9月烟台海港医院收治的82例老年高血压合并CHF患者为研究对象,按随机数字表法将其分为对照组与观察组,各41例。对照组采用贝那普利、美托洛尔治疗,观察组在对照组基础上加以益气通络汤治疗。对比两组临床疗效、血压变化、心功能、不良反应发生情况。结果观察组治疗总有效率为95.12%,高于对照组的78.05%,差异有统计学意义(P<0.05)。治疗后,观察组收缩压为(137.25±6.35)mmHg,舒张压为(80.35±5.29)mmHg,均低于对照组的(148.83±8.63)mmHg、(92.14±6.34)mmHg,左心室舒张末期内径为(35.73±3.57)mm,左心室收缩末期内径为(41.34±4.75)mm,均短于对照组的(45.21±4.13)mm、(48.20±6.21)mm,左室射血分数为(50.83±5.26)%,高于对照组的(44.28±4.01)%,组间差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论益气通络汤联合贝那普利及美托洛尔可降低老年高血压合并CHF患者的血压,改善心功能,且无严重不良反应。

沙库巴曲缬沙坦钠对慢性心力衰竭患者血管内皮功能和心率变异的影响

目的:探究沙库巴曲缬沙坦钠对慢性心力衰竭患者血管内皮功能和心率变异的影响。方法:回顾性分析2022年1月至2023年10月我院收治的慢性心力衰竭患者68例,按照治疗方法不同分为A组(沙库巴曲缬沙坦钠,n=35)和B组(缬沙坦,n=33)。比较两组慢性心力衰竭患者治疗前、治疗1 m后血管内皮功能(一氧化氮(Nitric oxide,NO)、内皮素1(Endothelin-1,ET-1)和血栓素2(Thromboxane 2,TVB2)),血压变异性(24 h收缩压标准差(24 h Standard deviation of systolic blood pressure,24 h SSD)、24 h舒张压标准差(24 h Standard deviation of diastolic blood pressure,24 h DSD)、日间收缩压标准差(Standard deviation of daytime systolic blood pressure,dSSD)、日间舒张压标准差(Standard deviation of diastolic blood pressure,dDsD)、夜间收缩压标准差(Standard deviation of nocturnal systolic blood pressure,nssD)和夜间舒张压标准差(Standard deviation of nocturnal diastolic blood pressure,nDsD),心肌酶谱(肌酸激酶(Creatine kinase,CK)、乳酸脱氢酶(Lactate dehydrogenase,LDH)、天门冬氨酸氨基转移酶(Aspartate aminotransferase,AST)、肌钙蛋白I(Troponin I,cTnI)水平,统计治疗不良反应。结果:治疗后,A组ET-1、TVB2水平均低于B组,NO水平高于B组(均P<0.05)。治疗后,A组慢性心力衰竭患者24 hSSD、24h DSD、dSSD、dDSD、nSSD和nDSD均低于B组(均P<0.05)。A组治疗后CK、LDH、AST和cTnI水平均低于B组(均P<0.05)。A组和B组水肿、低血压、尿频等不良反应总发生率分别为8.57%和15.15%(χ^(2)=0.709,P>0.05)。结论:沙库巴曲缬沙坦钠应用于治疗慢性心力衰竭能有效改善患者血管内皮功能、血压变异性和心肌酶谱,且安全性良好。

Why there is a need to discuss pulmonary hypertension other than pulmonary arterial hypertension?

Pulmonary hypertension(PH) is a condition characterized by the elevation of the mean pulmonary artery pressure above 25 mm Hg and the pulmonary vascular resistance above 3 wood units. Pulmonary arterial hypertension(PAH) is an uncommon conditionwith severe morbidity and mortality, needing early recognition and appropriate and specific treatment. PH is frequently associated with hypoxemia, mainly chronic obstructive pulmonary disease and DPLD and/or left heart diseases(LHD), mainly heart failure with reduced or preserved ejection fraction. Although in the majority of patients with PH the cause is not PAH, a significant number of published studies are still in regard to group Ⅰ PH, leading to a logical assumption that PH due to other causes is not such an important issue. So, is there a reason to discuss PH other than PAH? Chronic lung diseases, mainly chronic obstructive lung disease and DPLD, are associated with a high incidence of PH which is linked to exercise limitations and a worse prognosis. Although pathophysiological studies suggest that specific PAH therapy may benefit such patients, the results presented from small studies in regard to the safety and effectiveness of the specific PAH therapy are discouraging. PH is a common complication of left heart disease and is related to disease severity, especially in patients with reduced ejection fraction. There are two types of PH related to LHD based on diastolic pressure difference(DPD, defined as diastolic pulmonary artery pressure- mean PAWP): Isolated post-capillary PH, defined as PAWP > 15 mm Hg and DPD < 7 mm Hg, and combined post-capillary PH and pre-capillary PH, defined as PAWP > 15 mm Hg and DPD ≥ 7 mm Hg. The potential use of PAH therapies in patients with PH related to left heart disease is based on a logical pathobiological rationale. In patients with heart failure, endothelial dysfunction has been proposed as a cause of PH and hence as a target for treatment, supported by the presence of increased endothelin-1 activity and impaired nitric oxide-dependent vasodilation. Unfortunately, so far, there is no evidence supporting the use of specific PAH therapies in patients with PH related to left heart disease. In conclusion, the presence of PH in patients with conditions other than PAH contributes to the severity of the disease, affecting the outcome and quality of life. The disappointing results regarding the effectiveness of specific PAH therapies in patients withchronic lung diseases and LHD underline the need for seeking new underlying mechanisms and thus novel therapies targeting PH due to left heart disease and/or lung diseases.

沙库巴曲缬沙坦对心力衰竭合并肺动脉高压患者右心室功能的影响

目的利用超声心动图评价沙库巴曲缬沙坦对心力衰竭(以下简称心衰)合并肺动脉高压患者右心室功能的影响。方法前瞻性观察2020年9月至2021年3月于青岛大学附属医院确诊的心衰合并肺动脉高压的患者50例。根据心衰用药情况的不同,分为观察组(n=27)和对照组(n=23)。对照组在常规治疗的基础上应用缬沙坦,观察组在常规治疗的基础上应用沙库巴曲缬沙坦。利用超声心动图评价并比较治疗前和治疗6个月时患者的右心室功能参数[三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、右心室面积变化分数(fractional area change,FAC)、三尖瓣瓣环收缩期峰值速度(peak systolic myocardial velocity of tricuspid valve annulus,S’)]、右心室–肺动脉耦联参数[肺动脉收缩压(pulmonary artery systolic pressure,PASP)、三尖瓣环收缩期位移/肺动脉收缩压比值(TAPSE/PASP,T/P)]、左心重构指标[左房内径(left atrium diameter,LAD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室射血分数(left ventricular ejection fraction,LVEF)]的变化情况。结果治疗前,两组TAPSE、S’、FAC、PASP、T/P比值、LAD、LVEDD、LVESD、LVEF比较,差异均无统计学意义(P>0.05)。治疗6个月后,两组TAPSE、S’、T/P比值、LVEF均显著高于治疗前(P<0.05),PASP显著低于治疗前(P<0.05),LVEDD、LVESD显著小于治疗前(P<0.05)。对照组FAC、LAD与治疗前比较,差异均无统计学意义(P>0.05)。治疗后观察组TAPSE、S’、FAC、PASP、T/P比值、LAD、LVEDD、LVESD、LVEF的改善程度均显著优于对照组(P<0.05)。结论与缬沙坦相比,沙库巴曲缬沙坦不仅能改善心衰合并肺动脉高压患者左心重构,亦可有效改善右心室收缩功能,降低肺动脉压力,并对右心室–肺动脉耦联起到一定程度的改善作用。

沙库巴曲缬沙坦钠联合呋塞米治疗高血压伴慢性心力衰竭的临床疗效

目的:探讨沙库巴曲缬沙坦钠联合呋塞米治疗高血压伴慢性心力衰竭(CHF)的疗效及对心功能、炎症因子水平的影响。方法:选择2021年3月至2022年3月我院收治的100例高血压伴CHF患者展开研究,用简单随机数字表法将其分为观察组和对照组,每组各50例。对照组患者给予呋塞米治疗,观察组患者给予沙库巴曲缬沙坦钠+呋塞米联合治疗。治疗3个月后,比较两组患者临床疗效。记录患者治疗前后心功能[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)]、血压(舒张压、收缩压、心率)、血清炎症因子[N末端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)、血清肿瘤坏死因子-α(TNF-α)、心肌肌钙蛋白I(cTnI)]水平变化,记录两组患者不良反应。结果:观察组患者治疗总有效率为96.00%,高于对照组的80.00%(P<0.05)。治疗后,两组患者的LVEDD、LVESD水平均降低,观察组患者降低幅度大于对照组;两组患者LVEF水平均升高,观察组患者升高幅度大于对照组(P<0.05)。治疗后,两组患者的舒张压、收缩压、心率均降低,且观察组患者的降低幅度大于对照组(P<0.05)。治疗后,两组患者血清NT-proBNP、CRP、cTnI、TNF-α指标水平均降低,且观察组患者的降低幅度大于对照组(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论:沙库巴曲缬沙坦钠联合呋塞米治疗高血压伴CHF效果理想,可有效改善患者心功能,有效降低血清炎症因子水平,且不会增加不良反应。