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目的分析肼苯哒嗪联合螺内酯对产后妊娠高血压合并心力衰竭患者的疗效及对血浆脑利钠肽(BNP)和血管紧张素Ⅱ(AngⅡ)表达的影响。方法选取90例产后妊娠高血压性心力衰竭患者随机分为观察组和对照组各45例,对照组患者在常规治疗中接受肼苯哒嗪治疗,观察组患者进行肼苯哒嗪联合螺内酯治疗,观察两组患者治疗前、后心脏超声指标、心脏功能、BNP、AngⅡ变化及不良反应发生情况和6个月内心力衰竭恶化再住院情况。结果两组患者治疗前心脏超声指标差异无统计学意义(P>0.05),治疗后两组患者的左室大小指标均有改善;观察组治疗10 d、3个月、6个月后分别为(257.46±27.64)mm、(223.28±19.67)mm、(220.45±22.41)mm高于对照组(243.24±28.73)mm、(215.63±26.84)mm、(211.23±18.55)mm,两组比较差异有统计学意义(P<0.05)。观察组心功能改善总有效率93.33%高于对照组77.78%,两组差异有统计学意义(P<0.05)。两组患者治疗前BNP和AngⅡ差异无统计学意义(P>0.05),治疗后观察组患者BNP(386.23±47.52)pg/ml和AngⅡ(67.47±15.03)ng/L分别低于对照组BNP(452.13±96.78)pg/ml和AngⅡ(85.25±11.46)ng/L,两组差异有统计学意义(P<0.05)。观察组患者出现乳腺增生1例、咳嗽4例和6个月内心力衰竭恶化再住院2例,对照组乳腺增生6例、咳嗽11例和6个月内心力衰竭恶化再住院9例,两组差异均有统计学意义(P<0.05)。结论肼苯哒嗪联合螺内酯能有效改善产后妊娠高血压合并心力衰竭患者的临床症状,保证心脏功能,降低BNP、AngⅡ水平,减少不良反应情况发生,安全可靠,治疗效果显著,值得临床医学上推广和使用。
Objective To analyze the effects of hydralazine combined with spironolactone on post-partum pregnancy-induced hypertension patients with heart failure and its effect on plasma brain natriuretic peptide (BNP) and angiotensin Ⅱ (AngⅡ) expression. Methods Ninety patients with postpartum pregnancy-induced hypertension were randomly divided into observation group (45 cases) and control group (45 cases). Patients in the control group received hydralazine treatment in the routine treatment group, and hydralazine combined with spironolactone treatment group The echocardiographic parameters, heart function, BNP and Ang ¢ ò and adverse reactions in the two groups before and after treatment and the hospitalization of worsening heart failure within 6 months were observed. Results Before treatment, there was no significant difference in echocardiographic parameters between the two groups (P> 0.05). After treatment, the indexes of left ventricular size were improved in both groups. After 10 days, 3 months and 6 months of treatment, (215.23 ± 26.84) mm and (211.23 ± 18.55) mm respectively in the control group (257.46 ± 27.64) mm, (223.28 ± 19.67) mm and (220.45 ± 22.41) mm, which were significantly higher than those in the control group (243.24 ± 28.73) mm Statistical significance (P <0.05). The total effective rate of heart function improvement in observation group was 93.33%, which was significantly higher than that in control group (77.78%). There was significant difference between the two groups (P <0.05). There were no significant differences in BNP and AngⅡ between the two groups before treatment (P> 0.05). After treatment, the BNP levels in the observation group were lower than those in the control group (386.23 ± 47.52 pg / ml and AngⅡ (67.47 ± 15.03) ng / 452.13 ± 96.78) pg / ml and AngⅡ (85.25 ± 11.46) ng / L, respectively. There was significant difference between the two groups (P <0.05). In the observation group, one case of hyperplasia of mammary gland, four cases of cough and six cases of worsening of heart failure and hospitalization in six months, six cases of hyperplasia of mammary gland in control group, 11 cases of cough and 9 cases of further hospitalization for worsening of heart failure in six months. The differences were statistically significant (P <0.05). Conclusions Hydralazine combined with spironolactone can effectively improve the clinical symptoms of postpartum pregnancy-induced hypertension complicated with heart failure, ensure cardiac function, reduce BNP and AngⅡ levels and reduce adverse reactions, which is safe, reliable and effective in treatment. It is worthy of promotion in clinical medicine and use.