目的 分析厄贝沙坦+美托洛尔治疗慢性充血性心力衰竭(congestive heart failure,CHF)的临床效果及对患者心功能影响。方法 选取本院2018年12月—2020年12月住院治疗的200例慢性CHF患者,根据不同的治疗方法分组,参照组100例患者采用厄贝沙坦治疗,治疗组100例患者采用厄贝沙坦+美托洛尔治疗,比较2组临床疗效、心功能指标、血清炎性因子、血清N端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)水平、不良反应发生率。结果 治疗组临床总有效率(97.00%)高于参照组(87.00%),治疗组治疗后左室射血分数(left ventricular ejection fraction,LVEF)高于参照组,治疗组治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室收缩末期内径(left ventricular end systolic diameter,LVESd)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、NT-proBNP、Hcy水平均低于参照组,差异均具有统计学意义(P＜0.05)。治疗组不良反应发生率(4.00%)与参照组(5.00%)比较,P>0.05。结论 厄贝沙坦+美托洛尔可有效改善慢性CHF患者心功能,减轻炎症反应,抑制NT-proBNP、Hcy释放,且不良反应较少。

Objective To analyze the clinical effect of irbesartan combined with metoprolol in the treatment of chronic congestive heart failure (CHF) and its influence on cardiac function. Methods A total of 200 patients with chronic CHF in our hospital from December 2018 to December 2020 were selected and divided into two groups according to different treatment methods. One handred patients in the control group were treated with irbesartan, and 100 patients in the treatment group were treated with irbesartan + metoprolol. The clinical efficacy, cardiac function indexes, serum inflammatory factors, serum NT-proBNP, Hcy levels and adverse reactions of the two groups were compared. Results The total effective rate of the treatment group (97.00%) was higher than that of the control group (87.00%), LVEF of the treatment group was higher than that of the control group, LVEDd, LVESd, serum TNF-α, hs-CRP, IL-6, NT-proBNP, Hcy levels of the treatment group were lower than those of the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the treatment group (4.00%) was higher than that in the control group (5.00%),P>0.05. Conclusion Irbesartan + metoprolol could effectively improve cardiac function, reduce inflammatory reaction, inhibit the release of NT-proBNP and Hcy in patients with chronic CHF, with less adverse reactions.

目的 分析CT肺动脉栓塞指数(PAOI)与急性肺栓塞(APE)患者右心功能与预后的相关性。方法 以收治的86例疑似患者为研究对象,均行CT肺动脉成像(CTPA)检查,共60例APE患者,依据患者病情严重程度分为轻度、中度与重度,而无APE患者26例(对照组),分析左右心室最大短轴内径(RVd/LVd)、左右心室最大截面积比(RVA/LVA)、右心室短轴最大直径(RVMSA)、左心室短轴最大内径(LVMSA)、主肺动脉直径(MPAd)、上腔静脉直径(SVCd)、奇静脉直径(AZd)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)以及动脉血氧饱和度(SaO₂)与PAOI的相关性,并分析患者预后情况。结果 经比较,中、重度患者RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平高于轻度患者,而LVMSA低于轻度患者(P<0.05);且重度患者RVd/LVd、RVMSA水平高于中度,而RVA/LVA、LVMSA、MPAd与AZd水平比较无意义(P>0.05);3组SVCd水平比较P>0.05,其他参数指标比较差异明显(P<0.05);APE患者的PaO₂、PaCO₂以及SaO₂水平随着患者病情的加重呈现出逐渐下降趋势,且3组患者的PaO₂对比差异有统计学意义(P<0.05);PaO₂、PaCO₂和SaO₂与PAOI均呈负相关,且仅有PaO₂的差异存在统计学意义(P<0.05);POAI对APE患者的死亡有着一定的预测价值(P<0.05),最佳切点值58.91%,敏感度为85.29%,特异度为89.93%,其他数据未见明显诊断预测价值(P>0.05)。故RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平与PAOI成正相关,而LVMSA水平与PAOI成负相关,与SCVd无关。结论 PAOI与APE患者的右心功能各参数以及动脉血气各参数均有密切关联性,可将其作为患者预后评估的有效指标。

目的 探讨扩张型心肌病采用诺欣妥治疗的效果及对其心功能的影响。方法 本文将2020年2月—2020年10月收治的扩张型心肌病患者50例作为研究对象,对所有患者按照随机方式进行分组,对照组25例患者以常规抗心衰治疗与依那普利治疗,观察组25例患者在常规抗心衰治疗的基础上给予诺欣妥治疗,统计分析用药后有效率、治疗前后心功能指标、6 min步行距离及炎症因子水平。结果 两组之间炎症因子水平相比,观察组较对照组低;6 min步行距离、用药后有效率相比,观察组较对照组高;心功能指标相比,观察组SV、LVEF较对照组高,LVESD、LVEDD较对照组低,P＜0.05。结论 采用诺欣妥治疗扩张型心肌病效果显著,总有效率较好,可有效改善患者心功能指标,增加6 min步行距离,减轻炎症因子水平,改善患者预后。

目的 探讨生脉注射液联合环磷腺苷治疗慢性心力衰竭的临床疗效及对其心功能的影响。方法 选择本院2016年3月—2017年4月收治的90例慢性心力衰竭患者,随机将其分为2组,各45例。对照组采用环磷腺苷静脉滴注治疗,在此基础上观察组加用生脉注射液治疗,比较两组临床疗效、心功能及药物不良反应。结果 2个疗程后,观察组总有效率、LVEF、CI及CO水平均较对照组高,差异有统计学意义(P＜0.05);两组治疗期间药物不良反应率相比,差异无统计学意义(P＞0.05)。结论 生脉注射液联合环磷腺苷可提高慢性心力衰竭临床疗效,改善心功能,且用药安全性较高。

目的 探讨自体心包膜组织对急性心肌梗死大鼠心脏功能的影响。方法 筛选合格的模型动物随机分为三组:心包去除组:仅去除心包膜;心梗组:前降支结扎法建立大鼠心肌梗死模型3周后仅开胸;移植组:前降支结扎法建立大鼠心肌梗死模型,3周后将心包膜移植于心肌梗死及周边区。实验4周后,通过心动图评价实验动物心脏功能,使用Masson染色检测动物心肌梗死大小,通过免疫荧光评价动物心肌存活率、观察血管新生状况,Western blot检测Caspase-3蛋白/Bcl-2基因表达情况。结果 4周后,心包去除组大鼠的心电图监测结果未见有室性颤动;而心梗组、心梗+移植组均有非致死性室性颤动。相比心梗组,心梗+移植组改善了心功能,降低了心肌凋亡指数,免疫Bcl-2蛋白表达升高,而Caspase-3蛋白表达降低。结论 提示自体心包膜移植不会导致恶性室性心律失常,相对有较高的安全性;并能促进心肌梗死细胞恢复心功能,其改善机制可能与通过修补心室重构途径同时抑制缺血区域细胞凋亡有关。

Objective To explore the effect of autologous pericardial transplantation for treating the myocardial infarction (MI) in experimental rats. Methods 30 SD rats were randomly divided in to three equal parts: Pericardial removal group (PR group): only pericardium tissue was removed; Myocardial infarction group (MI group): the anterior descending branch ligation method established a rat model of myocardial infarction and only opened the chest after 3 weeks. Autologous pericardium transplantation (APT group): After established the MI model of SD rats, 3 weeks later, the autologous pericardial patch was harvested and transplanted to infarcted zone. Four weeks after the surgery, the cardiac function and serum biochemistry were analyzed for all the experimental rats. The cardiac function was evaluated by echocardiography, which the size of the infarction were examined by Masson staining, the survival time of transplanted autologous pericardial and angiogenesis were measured by immunohistochemistry, the protein expressions of Caspase and the gene expressions of Bcl were examined by Western blot analysis. Results 4 week after the 2^nd operation, no ventricular fibrillation was detected in the ECG of PR group. Fatal ventricular fibrillation wasn't detected in the ECG of MI group and APT group. Compared with MI group, APT group improved cardiac function and decreased myocardial apoptosis index(P<0.05),which similar to PR group. APT group has the higher density of angiogenesis at infracted area to MI group but less than that of PR group. PT group had decreased protein expressions of Caspase-3 and the expressions of Bcl-2 were decreased. Conclusion Autologous pericardial transplantation could recover myocardial infarction cells, which will improve the cardiac function in experimental rats with MI.

目的 探究曲美他嗪对慢性心力衰竭患者血清炎症因子水平及心功能的影响。方法 选择2015年4月—2016年3月我院收治的慢性心力衰竭患者94例,根据随机数表法分为两组,每组47例。对照组实施阿托伐他汀治疗,观察组在此基础上予以曲美他嗪治疗。比较两组患者治疗6个月后血清炎症因子和脑利钠肽(BNP)、心功能以及临床疗效。结果 观察组血清C-反应蛋白(CRP)、BNP、肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异有统计学意义(P＜0.05);观察组左收缩末期内径(LVESD)、左室舒张末期内径(LVEDd)水平较对照组明显降低,而左室射血分数(LVEF)高于对照组,差异有统计学意义(P＜0.05);观察组患者治疗有效率与对照组相比明显提高,差异有统计学意义(P＜0.05)。结论 对慢性心力衰竭患者实施曲美他嗪治疗,能有效提高患者临床疗效,降低患者血清炎症因子,改善心功能,值得临床推广与应用。

Objective To investigate the effect of Trimetazidine on serum inflammatory factors levels and cardiac function in patients with chronic heart failure (CHF). Methods 94 CHF patients admitted into our hospital from April 2015 to March 2016 were divided into two groups randomly, 47 cases in each. Control group took Atorvastatin, and on this basis observation group was given Trimetazidine. The serum inflammatory factors levels, brain natriuretic peptide (BNP), cardiac function and clinical efficacy of two groups after treatment for 6 months were compared. Results The serum C-reactive protein (CRP), BNP, Tumor necrosis factor-α (TNF-α) levels of observation group were lower than control group (P<0.05); The left ventricular end-systolic diameter (LVESD), Left ventricular end-diastolic diameter (LVEDd) levels of observation group significantly decreased compared with control group, but left ventricular ejection fraction (LVEF) was higher than control group (P<0.05); The curative effective rate of observation group significantly increased compared with control group (P<0.05). Conclusion Trimetazidine for treating CHF patients may effectively increase clinical efficacy, decrease serum inflammatory factors and improve cardiac function, which is worthy of clinical promotion and application.