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郑荷洁, 胡小翠. 二丁酰环磷腺苷钙可增强美托洛尔对老年心力衰竭合并心律失常患者的治疗效果[J]. koko体育app 学报(医学版), 2024, 55(3): 699-707. DOI:
引用本文: 郑荷洁, 胡小翠. 二丁酰环磷腺苷钙可增强美托洛尔对老年心力衰竭合并心律失常患者的治疗效果[J]. koko体育app 学报(医学版), 2024, 55(3): 699-707. DOI:
ZHENG Hejie, HU Xiaocui. Calcium Dibutyryl Adenosine Cyclophosphate Enhances the Effect of Metoprolol in Treating Older Adults With Heart Failure Combined With Arrhythmia[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(3): 699-707. DOI:
Citation: ZHENG Hejie, HU Xiaocui. Calciu൩m Dibutyryl Adenosine Cyclophosphate Enhances the Effect of Metoprolol in Treating Older Adults With Heart Failure Combined With Arrhythmia[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(3): 699-707. DOI:

二丁酰环磷腺苷钙可增强美托洛尔对老年心力衰竭合并心律失常患者的治疗效果

Calcium Dibutyryl Adenosine Cyclophosphate Enhances the Effect of Metoprolol in Treating Older Adults With Heart Failure Combined With Arrhythmia

  • 摘要:
    目的 探讨老年心力衰竭合并心律失常患者二丁酰环磷腺苷钙(dbcAMP-Ca)联合美托洛尔治疗效果及安全性。
    方法 选取本院2021年2月–2023年4月102例老年心力衰竭合并心律失常患者,由独立于研究外的工作人员将招募名单输入随机数据库,采用SAS9.4软件生成随机分配序列,按照1∶1的比例分为试验组(n=51)与对照组(n=51)。对照组给予美托洛尔初始剂量6.25 mg/d,逐渐增量至目标剂量25 mg/d;试验组给予dbcAMP-Ca联合美托洛尔治疗,美托洛尔给药方式同对照组,加用dbcAMP-Ca(40 mg/次,静脉滴注,1次/d)。两组均维持治疗4周。主要结局指标为各组的临床治疗有效率(该组达到显效和有效的例数/该组总例数),次要指标为各组的心功能、心率变异性、运动能力、血液流变学、心肌损伤指标、炎性指标及不良反应发生情况。
    结果 两组临床治疗有效率对比,试验组94.12%(48/51)高于对照组78.43%(40/51),差异有统计学意义(P<0.05)。心功能方面,试验组治疗后左心室舒张、收缩末期内径(LVEDD、LVESD)、室间隔厚度小于对照组,左心室射血分数、每搏心输出量水平高于对照组(P<0.05)。心率变异性方面,试验组治疗后NN间期标准差/平均值标准差(SDNN、SDANN)、相邻NN差50 ms以上占总窦性心搏个数比例(PNN50%)、相邻RR间期差值均方根(RMSSD)水平高于对照组(P<0.05)。运动能力方面,试验组治疗后6 min步行距离大于对照组(P<0.05)。血液流变学方面,试验组治疗后血小板聚集率、纤维蛋白原、血沉、全血黏度水平低于对照组(P<0.05)。心肌损伤指标方面,试验组治疗后血清N末端B型利钠肽原、心肌肌钙蛋白I水平低于对照组,类胰岛素生长因子 1、心肌营养素1水平高于对照组(P<0.05)。炎性指标方面,试验组治疗后血清炎性指标白细胞介素-6、高敏C反应蛋白、肿瘤坏死因子-α水平低于对照组(P<0.05)。治疗期间,试验组不良反应发生率(9.80%)与对照组(7.84%)相当(P>0.05)。
    结论 在美托洛尔的基础上联合使用dbcAMP-Ca,可有效提高老年心力衰竭合并心律失常患者心功能,改善心率变异性,提高运动耐量,抑制机体炎性反应,用药安全性较高,治疗效果好于单用美托洛尔。
     
    Abstract:
    Objective  To explore the effect and safety of calcium dibutyryl adenosine cyclophosphate (dbcAMP-Ca) combined with metoprolol in the treatment of older adults with heart failure combined with arrhythmia.
    Methods  A total of 102 elderly patients with heart failure combined with arrhythmia were enrolled in our hospital between February 2021 and April 2023. The list of patients enrolled was entered into a random database by independent staffs not involved in the study and random assignment sequences were generated by the SAS9.4 software. Then, the 102 elderly patients were divided into a control group (n=51) and an experimental group (n=51). Patients in the control group were given metoprolol at an initial dose of 6.25 mg/d, which was gradually increased to the target dose of 25 mg/d. Patients in the experimental group were given 40 mg of dbcAMP-Ca once a day via intravenous drip in addition to the treatment given to the control group. Both groups were treated for 4 weeks. The rate of effective response to clinical treatment (the number of cases achieving significant effects and those achieving some effects divided by the total number of cases in the group) was defined as the main outcome index. Secondary indexes included cardiac function, heart rate variability, exercise ability, hemorheology, myocardial injury indexes, inflammatory indexes, and the occurrence of adverse reactions.
    Results  The rate of effective response to clinical treatment was higher in the experimental group than that in the control group (94.12% 48/51 vs. 78.43% 40/51, P<0.05). After treatment, the left ventricular end-diastolic and end-systolic dimensions (LVEDD and LVESD) and the interventricular septal thickness (IVS) were lower in the experimental group than those in the control group, while the left ventricular ejection fraction (LVEF) and the stroke volume (SV) were higher in the experimental group than those in the control group (P<0.05). In terms of heart rate variability after treatment, the standard deviation of all the normal-to-normal intervals/the average of all the normal-to-normal intervals (SDNN/SDANN), the percentage of NN50 in the total number of normal-to-normal intervals (PNN50%), and the root mean square of the differences between adjacent normal-to-normal intervals/root mean square differences of successive R-R intervals (RMSSD) were higher in the experimental group than those in the control group (P<0.05). In terms of exercise capacity after treatment, the subjects in the experimental group covered more distance in the 6-min walk test than those in the control group did (P<0.05). In terms of the hemorheology indexes after treatment, the levels of platelet aggregation rate (PAgT), fibrinogen (FIB), erythrocyte sedimentation rate (ESR), and whole blood viscosity (ηb) were lower in the experimental group than those in the control group (P<0.05). In terms of the myocardial injury indexes after treatment, the levels of serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) and cardiac troponin I (cTnI) were lower in the experimental group than those in the control group, while the levels of insulin-like growth factor 1 (IGF-1) and cardiotrophin 1 (CT-1) were higher in the experimental group than those in the control group (P<0.05). In terms of the inflammatory indexes after treatment, the levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) were lower in the experimental group than those in the control group (P<0.05). The incidence of adverse reactions in the experimental group (9.80%) and that in the control group (7.84%) were comparable (P>0.05).
    Conclusion  The use of dbcAMP-Ca in addition to metoprolol can effectively improve cardiac function, heart rate variability, and exercise tolerance, while inhibiting inflammatory response in elderly patients with heart failure combined with arrhythmia, with high medication safety. The combination medication shows better safety and therapeutic effects than those of metoprolol used alone.
     

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