| Objective:This article through observation of cedilanid + standard of acute heart failure(AHF)treatment on the basis of the clinical curative effect of levosimendan combined with drugs in the treatment of acute heart failure,to investigate and analyze the effects of combined therapy on cardiac function,neuroendocrine and inflammatory markers in patients.Methods:This study selected from January 2014 to January 2016 in the First Affiliated Hospital of Zhengzhou University and the Zhengzhou people's Hospital of the AHF patients with a total of 120 cases were divided into control group(cedilanid + standard drug treatment of acute heart failure)and treatment group(cedilanid + standard drug of acute heart failure+ levosimendan),60 cases each.After admission,two groups of patients received medical history,and routine physical examination(including blood pressure,heart rate,etc.),before treatment,were detected left ventricular ejection fraction(LVEF%),strokevolume(SV),N-terminal B type natriuretic peptide(NT-proBNP),norepinephrine(NE),interleukin-6(IL-6),high sensitive C reactive protein(hs-CRP)content.Routine treatment(oxygen inhalation,monitoring,etc),standard drug treatment of acute heart failure was also given: angiotensin converting enzyme(ACEI)inhibitors or angiotensin II receptor antagonist(ARB),aldosterone receptor antagonist(MRA),diuretics,nitrates and sodium nitroprusside treatment.The control group was treated on the basis of standard drug treatment of acute heart failure,according to the patient's heart rate,on the day of admission given intravenous injection of cedilanid(5% Glucose Injection Cediland diluted slowly intravenously,the first dose of 0.2-0.4mg,according to the patient's symptoms and heart rate,4-6 hours can again give 0.2-0.4mg intravenous injection);.The combined treatment group after admission on the basis of control group treatment with levosimendan(after the initial loading dose of 6?g/kg,time is more than 10 minutes,maintain the infusion of 0.1?g/kg/min,ensure the systolic pressure is above 90 mmHg,the average pressure is above 65mmHg),.Two groups of patients with real-time ECG monitoring and monitoring of blood pressure,the clinical symptoms of the patients were observed,after 24 hours,the liver and kidney function,electrolytes,LVEF,SV,NT-proBNP,NE,IL-6,hs-CRP levels were measured.Using descriptive analysis,research methods and qualitative research methods to analyze the data,the difference between the two groups of treatment effect,two groups of patients effective rate of count data recovery(%)said,take ?2 test comparison;two groups of age,gender and other measurement data to mean + standard deviation(x ±s),between the two groups were compared using the t test,to determine P value was meaningless,if P<0.05,to determine the two groups was statistically significant,on the contrary,there is no statistical significance.Results:(1)Combined treatment group 38 cases of male patients,22 female patients,age 30-78 years old,average age(60.52±9.33)years old,the duration of the disease ranged from 1 to 5 years,the average duration of(3.85±1.54)years,Routine examination of systolic blood pressure(134.63±23.45)mmHg,diastolic blood pressure(81.32±14.36)mmHg,heart rate(92.10±15.97)bpm.In the past,27 cases were orally treated with ACEI or ARB,30 cases with oral diuretics,40 cases with oral nitrates,and 39 cases with oral beta blocker,patients were treated with the left ventricular ejection fraction(LVEF%)was(28.93 ± 3.90)%,strokevolume(SV)(51.05±4.33),N-terminal B type natriuretic peptide(NT-proBNP)is(8411.43±467.56)pg/ml,norepinephrine(NE)for(202.73±45.93)pg/ml,interleukin-6(IL-6)is(30.63±4.64)ng/ml,high sensitive C reactive protein(hs-CRP)is(8.61±1.95)pg/ml;the control group 43 cases were male,17 female patients,aged 32-76 years old,average age(59.37±8.92)years old,the duration of the disease ranged from 1 to 5 years,the average duration of(4.17±1.43)years.Routine examination of systolic blood pressure 140.37± 20.78)mmHg,diastolic blood pressure(84.98 ± 11.13)mmHg,heart rate(90.78±21.04)bpm,34 cases of oral ACEI or ARB drugs,32 cases of oral diuretics,oral nitrates in 43 cases,35 cases of oral beta blocker,patients before receiving treatment,left ventricular ejection fraction(LVEF%)was(27.97±2.86)%,the strokevolume(SV)for(50.45±5.25),N-terminal B type natriuretic peptide(NT-proBNP)is(8295.77±527.09)pg/ml,norepinephrine(NE)for(216.37±46.70)pg/ml,interleukin-6(IL-6)is(31,15±4.12)ng/ml,high sensitive C reactive protein(hs-CRP)is(8.33±1.74)pg/ml?The two groups in age,gender,disease duration,blood pressure,heart rate,medical history(ACEI or ARB,diuretics,nitrates,beta blockers),before treatment,LVEF,SV,NT-proBNP,NE,IL-6,hs-CRP and so on were compared with the normal data showed no significant difference(P > 0.05)can be compared.(2)The combined treatment group after treatment in patients with LVEF and SV was significantly higher than that before treatment,[LVEF:(41.02±5.15)% vs(28.93±3.90)%;SV:(54.85±5.34)vs(51.05±4.33)ml],the difference was statistically significant(P < 0.05);patients in the control group after treatment compared with the treatment of LVEF before the rise: [(35.97±4.77)% vs(27.97±2.86)detected the difference was statistically significant(P < 0.05),and after treatment,SV did not change significantly compared with before: [(51.83±3.70)vs(50.45±5.25)ml],the difference was not statistically significant(P > 0.05);(3)The combined treatment group compared with the control group after treatment in patients with LVEF,SV significantly increased [LVEF:(41.02±5.15)% vs(35.97±4.77)%;SV:(54.85±5.34)vs(51.83±3.70)ml],the difference was statistically significant(P < 0.05);(4)The combined treatment group after treatment in patients with NT-proBNP and NE content were significantly lower than those before treatment: [NT-proBNP:(6112.88±215.44)vs(8411.43±467.56)pg/ml;NE:(181.88±31.11)vs(202.73±45.93)pg/ml],the difference was statistically significant(P < 0.05);the content of NT-proBNP in the in the control group after treatment than before comparison: [(7117.33±873.16)vs(8295.77±527.09)(pg/ml]),the difference was statistically significant(P< 0.05),and after treatment,the content of NE did not change significantly before treatment: [(212.20±47.62)vs(216.37±46.70)pg/ml],the difference was not statistically significant(P > 0.05);(5)The combined treatment group compared with the control group of patients after treatment,the content of NT-proBNP and NE decreased significantly,[NT-proBNP:(6112.88±215.44)vs(7117.33±873.16)pg/ml;NE:(181.88±31.11)vs(212.20±47.62)pg/ml],the difference was statistically significant(P < 0.05);(6)The combined treatment group after treatment in patients with IL-6 and hs-CRP content decreased,[IL-6:(24.21±3.04)vs(30.63±4.64)ng/ml;hs-CRP:(6.67±1.75)vs(8.61±1.95)pg/ml],the difference was statistically significant(P < 0.05);patients in the control group after treatment compared with IL-6 content decreased: [(25.97±3.15)vs(31,15±4.12 ng/ml],the difference was statistically significant(P<0.05),but after treatment,the content of hs-CRP did not change significantly before treatment: [(8.13±2.27)vs(8.33±1.74)pg/ml],the difference was not statistically significant(P > 0.05);(7)The combined treatment group compared with the control group of patients after treatment,the content of IL-6 and hs-CRP decreased significantly,[IL-6:(24.21±3.04)vs(25.97±3.15)ng/ml;hs-CRP(6.67±1.75)vs(8.13±2.27)pg/ml],the difference was statistically significant(P < 0.05);(8)According to the evaluation criteria,the combined treatment group 55 cases with total efficiency,total effective rate 91.7%;The control group 46 cases with total efficiency,total effective rate 76.7%.Treatment of patients with total efficiency between the two groups,there was significant statistical difference(?2= 5.065,P =0.024< 0.05);(9)The combined treatment group 1 cases of abnormal liver and kidney function,electrolyte changes in 1 cases,no severe hypotension,arrhythmia and death in patients with a total of 2 cases of adverse events,the incidence rate was 3.3%;the control group occurred in 1 cases of abnormal liver and kidney function,severe hypotension and malignant arrhythmia were 1 cases each.No change of electrolyte and death in patients with a total of 3 cases of adverse events,the incidence of adverse events in the process of 5%.treatment in the two groups were compared,the difference was not statistically significant(P =0.651 > 0.05).Conclusion:(1)Cedilanid+standard drug treatment on the basis of acute heart failure,combined with levosimendan in the treatment of AHF can significantly enhance the myocardial contractility of patients,improve the patient's LVEF and SV.(2)Cedilanid + standard drug treatment on the basis of acute heart failure,combined with levosimendan in the treatment of AHF can significantly reduce the content of NT-proBNP and NE in patients with heart failure,thereby inhibiting the interaction of neuroendocrine cytokines;at the same time can significantly reduce the content of IL-6 and hs-CRP in patients,thereby inhibiting inflammation in patients.(3)The contents of LVEF?NT-proBNP,NE,IL-6 and hs-CRP were reduced as the criteria for evaluating the therapeutic effect and prognosis,which were consistent with the clinical course of heart failure.(4)Compared with cedilanid + acute heart failure standard drug treatment,combined with levosimendan treatment AHF adverse events(abnormal liver and kidney function,electrolyte changes,hypotension,arrhythmia,death)occurred without significant change.(5)With cedilanid + acute heart failure drug treatment on the basis of standard,combined with levosimendan treatment can reflect the remarkable curative effect in the application of 24 hours. |
PDF Full Text Request