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目的研究米力农联合去乙酰毛花苷在慢性心力衰竭(chronic heart failure,CHF)并发心房颤动(房颤)患者心功能不全急性加重期的应用效果及其与去乙酰毛花苷和米力农单独应用的对比研究。方法选取CHF并发房颤,纽约心脏协会(New York Heart Association,NYHA)心功能分级III~IV级的患者162例。所有患者均在CHF和房颤以及原发病等常规治疗的基础上,按电脑随机数字表法分为3组:去乙酰毛花苷组(n=52)、米力农组(n=53)、去乙酰毛花苷联合米力农组(n=57)。患者治疗前除常规检查外,均按NYHA进行心功能分级,检测6 min步行距离、心率、超声心动图,并于治疗后第7天复查上述结果。同时于治疗前、治疗后第1、3、5、7天查血清N末端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-pro BNP)浓度。结果去乙酰毛花苷组、米力农组治疗后6 min步行距离、心率等均较治疗前明显改善;血清NT-pro BNP浓度比治疗前降低,差异有统计学意义(P<0.05)。两组左心室射血分数虽有所改善,但差异无统计学意义(P>0.05)。两组左心室舒张末期内径治疗前、后比较,差异无统计学意义(P>0.05)。去乙酰毛花苷联合米力农组治疗后6 min步行距离、心率、左心室射血分数改善比单独用药组明显;血清NT-pro BNP浓度比单独用药组治疗后下降更多,差异有统计学意义(P<0.05)。结论 CHF并发房颤心功能不全急性加重的患者在常规治疗的基础上短期予以短暂应用去乙酰毛花苷或米力农,均能很好地改善心功能指标、降低血清NT-pro BNP浓度、改善预后,并且以去乙酰毛花苷联合米力农效果更为显著。
Objective To study the clinical effect of milrinone combined with stilbene glycoside in acute exacerbation of cardiac insufficiency in patients with chronic heart failure (CHF) complicated with atrial fibrillation (AF) A Comparative Study of Individual Application of Farmers. Methods A total of 162 CHF patients with atrial fibrillation and New York Heart Association (NYHA) were enrolled in the study. All patients were divided into 3 groups according to computer random number table based on conventional therapy such as CHF, atrial fibrillation and primary disease: stilbene group (n = 52), milrinone group (n = 53) ), Stilbene plus milrinone (n = 57). Patients before treatment in addition to routine examination, according to NYHA cardiac function classification, detection of 6 min walking distance, heart rate, echocardiography, and 7 days after treatment to review the above results. At the same time, the concentrations of serum N-terminal pro-B-type natriuretic peptide (NT-pro BNP) were detected on the 1st, 3rd, 5th and 7th day after treatment. Results The distance of walking, heart rate and other parameters were significantly improved at 6 min after treatment in the stilbene group and the milrinone group. The serum NT-pro BNP concentration was significantly lower than that before treatment (P <0.05). Although left ventricular ejection fraction improved, the difference was not statistically significant (P> 0.05). The left ventricular end-diastolic diameter of the two groups before and after treatment, the difference was not statistically significant (P> 0.05). The improvement of walking distance, heart rate and left ventricular ejection fraction at 6 min after treatment with stilbene combined with milrinone was more significant than that of the drug alone group. The serum NT-pro BNP concentration decreased more than that of the drug alone group after treatment, with statistical difference Significance (P <0.05). Conclusions Short-term administration of stilbene or milrinone to patients with CHF complicated with atrial fibrillation with acute cardiac dysfunction on the basis of routine treatment can improve cardiac function indexes, decrease serum NT-pro BNP concentration, Improve prognosis, and combined with stilbene glucoside more significant effect of milrinone.