伊伐布雷定联合托拉塞米治疗老年慢性心力衰竭的疗效及对相关指标的影响^*

Efficacy of ivabradine combined with torasemide in elderly patients with chronic heart failure and its effect on heart failure-related indices

摘要

目的 分析老年慢性心力衰竭 (CHF) 患者应用伊伐布雷定联合托拉塞米的疗效及对 CHF 相关指标的影响。方法 选取 2021 年 2 月—2023 年 9 月中国人民解放军联勤保障部队第九六○医院收治的 105 例老年 CHF 患者的临床资料进行回顾性分析, 按照不同治疗方法将其分为对照组和观察组, 对照组 52 例接受托拉塞米治疗, 观察组 53 例在对照组基础上加用伊伐布雷定治疗, 比较两组疗效、心力衰竭指标、生活质量及安全性。结果 观察组治疗有效率高于对照组 (P<0.05)。 治疗 3 个月, 两组左室射血分数、血管内皮生长因子、6 ^{min 内步行距离均高于治疗前, 且观察组高于对照组 (P<0.05); 左室收缩末期内径、N 末端脑钠肽前体、心肌钙蛋白Ⅰ、血清一氧化氮、脑钠肽、C 反应蛋白水平和明尼苏达心衰生活质量量表评分均低于治疗前, 且观察组低于对照组 (P<0.05)。 两组不良反应总发生比较, 差异无统计学意义 (P>0.05)。结论 老年 CHF 患者采取伊伐布雷定联合托拉塞米治疗可显著改善血管内皮功能、心功能和心肌指标, 减轻心力衰竭程度, 提升患者生活质量。}

Abstract

Objective To analyse the efficacy of ivbabradine in combination with torasemide in elderly patients with chronic heart failure (CHF) and its effect on heart failure-related indices. Methods The clinical data of 105 elderly patients with CHF admitted to the 960th Hospital of the PLA Joint Logistics Support Force from February 2021 to September 2023 were retrospectively analyzed and divided into the control group and the observation group according to different treatment methods. 52 patients in the control group received torasemide treatment, and 53 patients in the observation group were treated with ivabradine on the basis of the control group. The efficacy, heart failure indicators, quality of life and safety were compared between the two groups. Results The effective rate in the observation group was higher than that in the control group (P<0.05). At 3 months of treatment, the levels of left ventricular ejection fraction, vascular endothelial growth factor, and walking distance in 6 min in the two groups were higher than those before treatment, and in the observation group were higher than those in the control group (P<0.05), and the levels of left ventricular end-systolic diameter, N-terminal pro-brain natriuretic peptide precursor, cardiac troponin Ⅰ, serum nitric oxide, brain natriuretic peptide, and C-reactive protein levels and Minnesota living with heart failure questionnaire score in the two groups were higher than those before treatment, and in the observation group were lower than those in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion In elderly patients with CHF, Ivabradine combined with torasemide can significantly improve vascular endothelial function, cardiac function and myocardial indexes, reduce the degree of heart failure, and improve the quality of life of patients.

关键词

慢性心力衰竭 / 伊伐布雷定 / 托拉塞米

Key words

Chronic heart failure / Ivabradine / Torasemide

参考文献

[1] 林娜, 黄秀芳, 孙洁, 等 . 强化心力衰竭易损期随访对慢性心力衰竭患者预后的影响[J]. 广西医学, 2021, 43(21): 2621-2624.

[2] Lin N, Huang X F, Sun J, et al. Impact of intensive heart failure vulnerability follow—up on the prognosis of patients with chronic heart failure[J]. Guangxi Med J, 2021, 43(21): 2621-2624.

[3] 张洪磊, 韦彩雯 . 益气养阴活血补心汤辅助西药对老年慢性心衰心室重构及血清 sST2、Galectin—3、LN、PⅢP 的影响[J]. 中药材, 2021, 44(3): 715-719.

[4] Zhang H L, Wei C W. Effects of Yiqi, nourishing Yin, activating blood and tonifying heart soup adjunctive western medicine on ventricular remodelling and serum sST2, Galectin—3, LN and PⅢP in elderly chronic heart failure[J]. J Chin Med Mater, 2021, 44(3): 715-719.

[5] Wang B, Liu J, Zhao L . Association of congestive heart failure with mortality in individuals with rheumatoid arthritis: a cohort study[J]. Clin Rheumatol, 2024, 43(4): 1287-1297.

[6] Tu S, Ye L, Shen C, et al. Analysis of the predictive efficacy of serum suPAR combined with APN and IgE test and the relationship of patients with CHF and cardiac function[J]. Altern Ther Health Med, 2024, 30(4): 124-129.

[7] 冯春前, 赖晖明 . 新型袢利尿剂托拉塞米在心衰患者临床治疗中的应用研究进展[J]. 中国实用医药, 2024, 19(14): 178-180.

[8] Feng C Q, Lai H M. Research progress on the application of new loop diuretic torsemide in the clinical treatment of patients with heart failure[J]. Chin Pract Med, 2024, 19(14): 178-180.

[9] 孙海英 . 托拉塞米联合左西孟旦治疗慢性心力衰竭急性加重期效果研究[J]. 中国药物与临床, 2021, 21(2): 273-274.

[10] Sun H Y. Study on the effect of torasemide combined with levosimendan in the treatment of acute exacerbation of chronic heart failure[J]. Chin Remed Clin, 2021, 21(2): 273-274.

[11] Greene S J, Butler J, Albert N M, et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP—HF registry[J]. J Am Coll Cardiol, 2018, 72(4): 351-366.

[12] 许顶立, 白煜佳 . 2017 ACC/AHA/HFSA 心力衰竭管理指南更新解读[J]. 中国全科医学, 2017, 20(29): 3579-3583.

[13] Xu D L, Bai Y J. Interpretation of 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure[J]. Chin Gen Pract, 2017, 20(29): 3579-3583.

[14] Mogle J, Buck H, Zambroski C, et al. Cross—validation of the minnesota living with heart failure questionnaire[J]. J Nurs Scholarsh, 2017, 49(5): 513-520.

[15] 邓莹, 李慧, 潘雪瑾, 等 . 生脉注射液联合托拉塞米治疗慢性心力衰竭的临床研究[J]. 现代药物与临床, 2023, 38(1): 105-109.

[16] Deng Y, Li H, Pan X J, et al. Clinical study on Shengmai injection combined with torsemide in treatment of chronic heart failure[J]. Drugs Clin, 2023, 38(1): 105-109.

[17] Gan J, Wang Y, Deng Y, et al. Sacubitril/valsartan ameliorates cardiac function and ventricular remodeling in CHF rats via the inhibition of the tryptophan/kynurenine metabolism and inflammation[J]. Sci Rep, 2024, 14(1): 12377.

[18] Tarlovskaya E I, Omarova Y V . Analysis of the compliance of the prescribed therapy with the EURO FORTA system in polymorbidic patients of elderly and old age with CHF[J]. Kardiologiia, 2021, 61(11): 57-64.

[19] 任欣, 申思, 易琼, 等 . 苓桂术甘汤加减联合托拉塞米治疗心力衰竭临床研究[J]. 山东中医杂志, 2022, 41(3): 270-275.

[20] Ren X, Shen S, Yi Q, et al. Clinical study of modified Linggui Zhugan Decoction combined with torasemide in treatment of heart failure[J]. Shandong J Tradit Chin Med, 2022, 41(3): 270-275.

[21] 牛川, 冯志鹏, 赵连玮 . 芪苈强心胶囊与托拉塞米对慢性充血性心力衰竭病人心室重塑及血清 miR—210—3p、miR—423—5p 的影响[J]. 中西医结合心脑血管病杂志, 2024, 22(16): 3004-3008.

[22] Niu C, Feng Z W, Zhao L W. Effects of Astragalus Hebecarpa strong heart capsule and torasemide on ventricular remodelling and serum miR—210—3p and miR—423—5p in patients with chronic congestive heart failure[J]. Chin J Integr Med Cardio—Cerebrovasc Dis, 2024, 22(16): 3004-3008.

[23] 包红, 黄善慧, 李爽, 等 . 灯盏生脉胶囊联合伊伐布雷定治疗慢性心力衰竭的临床研究[J]. 现代药物与临床, 2024, 39(7): 1773-1779.

[24] Bao H, Huang S H, Li S, et al. Clinical study of Dengzhan Shengmai Capsules combined with ivabradine in treatment of chronic heart failure[J]. Drugs Clin, 2024, 39(7): 1773-1779.

[25] 高洁, 董蔚 . 伊伐布雷定在心力衰竭合并非阵发性心房颤动患者中的应用研究进展[J]. 心血管病学进展, 2022, 43(9): 778-782.

[26] Gao J, Dong W. Application of ivabradine in patients with heart failure complicated with non—paroxysmal atrial fibrillation[J]. Adv Cardiovasc Dis, 2022, 43(9): 778-782.

[27] 刘薇, 李凤娥, 苏萍, 等 . 真武汤联合补心气方加味治疗心肾阳虚型慢性心力衰竭患者的疗效及对其氧化应激反应、血管内皮功能的影响[J]. 世界中西医结合杂志, 2024, 19(6): 1238-1242.

[28] Liu W, Li F E Su P, et al. Efficacy of Zhenwu Decoction combined with modified Buxinqi prescription in treatment of patients with chronic heart failure of heart and kidney Yang deficiency and its effects on oxidative stress and vascular endothelial functions[J]. World J Integr Tradit West Med, 2024, 19(6): 1238-1242.

[29] 马亮, 关晓楠, 刘文婷, 等 . 伊伐布雷定在脓毒症合并急性心力衰竭易损期患者中应用 1 年随访疗效分析[J]. 中国急救医学, 2021, 41(9): 759-763.

[30] Ma L, Guan X T, Liu W T, et al. One—year follow—up of ivabradine in the patients with sepsis complicated with acute heart failure in the vulnerable period[J]. Chin J Crit Care Sep, 2021, 41(9): 759-763.

[31] 梁建军, 徐元胜, 刘锦涛 . 伊伐布雷定治疗高血压合并心力衰竭老年患者的临床研究[J]. 中国临床药理学杂志, 2024, 40(20): 2920-2923.

[32] Liang J J, Xu Y S, Liu J Y. Clinical trial of ivabradine in the treatment of elderly hypertensive patients with heart failure[J]. Chin J Clin Pharmacol, 2024, 40(20): 2920-2923.

[33] 陈琮玲, 杨贤, 吴韩, 等 . 伊伐布雷定联合 β 受体阻断剂治疗慢性心力衰竭的有效性和安全性的 Meta 分析[J]. 中国医院用药评价与分析, 2024, 24(4): 459-464.

[34] Yang Z L, Yang X, Wu H, et al. Meta—analysis on efficacy and safety of ivabradine combined with β—blockers in the treatment of chronic heart failure[J]. Chin Hosp Drug Eval Anal, 2024, 24(4): 459-464.

[35] 张峰, 李云妮 . 托拉塞米联合呼吸机对心力衰竭患者心室重构及心功能的影响[J]. 贵州医药, 2024, 48(6): 882-884.

[36] Zhang F, Li Y N. Effect of torasemide combined with ventilator on ventricular remodelling and cardiac function in patients with heart failure[J]. Guizhou Med J, 2024, 48(6): 882-884.

[37] 樊毅虎, 宋小妮 . 诺迪康胶囊联合托拉塞米对慢性充血性心力衰竭患者血清脑利钠肽、内皮素水平的影响[J]. 检验医学与临床, 2023, 20(13): 1969-1972.

[38] Fan Y H, Song X N. Effect of Nordicam capsule combined with torasemide on serum brain natriuretic peptide and endothelin levels in patients with chronic congestive heart failure[J]. Lab Med Clin, 2023, 20(13): 1969-1972.

基金资助

^*军队后勤科研项目保健专项课题(23BJZ45)