| Objective: This study is based on the treatment of coronary heart disease plus alprostadil,by observing the impact of myocardial ischemia and heart rate variability for elderly patients with coronary heart disease to provide new treatment of myocardial ischemia.Methods: Selected from January 2016 to January 2017 in Baoding City First Hospital Geriatrics hospitalized treatment of 70 elderly patients with coronary heart disease myocardial ischemia.Types of cases: According to the classification of coronary heart disease in elderly patients,the patients with angina pectoris,vasospasm caused by angina pectoris,asymptomatic angina pectoris,ischemic cardiomyopathy and unstable angina pectoris(UA).Selection criteria: 1)age 60-80 years;2)coronary heart disease history of10 to 20 years,confirmed patients with coronary heart disease;3)cardiac function ?~? level.4)no acute myocardial infarction occurred in the past2 months;5)no serious arrhythmia;6)not suffering from acute or chronic heart failure;7)blood pressure does not exceed 160 / 100 mmHg.8)angina symptoms occur 5-10 times a week;9)not suitable for coronary intervention or refused to line coronary intervention.Exclusion criteria: 1)does not meet the requirements of the above cases;2)patients with mental illness;3)incomplete information on the results of the study;4)also suffering from glaucoma or high intraocular pressure;5)patients with interstitial pneumonia;Combined with chronic / acute gastritis,gastric ulcer patients.7)patients with bleeding tendency;8)allergic to alprostadil.Grouping: Patients were divided into two groups by randomized control,35 patients(age 65±7 years)in the treatment group and 35 patients(68±9years)in the control group.Control group: the use of conventional drugtreatment: oral nitric acid isosorbide tablets 10 mg 3 times a day,aspirin enteric-coated tablets 100 mg once a day,clopidogrel tablets 75 mg once a day,atorvastatin calcium tablets 10 mg daily 1 Times,tricamazepine tablets 20 mg 3times a day,subcutaneous injection of low molecular weight heparin calcium5000 units 2 times a day,static point Shuxu pass 6ml 1 day.Treatment group:in the conventional treatment based on the drug plus alizarin injection 10 ug into the pot static point once a day.Both groups were treated for 2 weeks.Before treatment and fourteenth days after treatment check electrocardiogram,dynamic electrocardiogram,echocardiography(for determination of left ventricular ejection fraction and cardiac minute output),plasma BNP,and record the time / frequency in two groups before and after treatment of angina pectoris,and continued every week.Two groups were observed before and after treatment: 1 patients with angina pectoris times / week,every time the degree of pain and the duration of the attack,the total time per week;2,before and after the treatment of resting ECG ST segment depression and recovery;3,24 hours dynamic electrocardiogram ST segment of the total time and total number of heart rate variability index(SDNN,SDANN)changes;4,left ventricular ejection fraction(LVEF%),cardiac output(CO L/min)the degree of improvement;5,the decrease of plasma BNP.Finally,the curative effect of the two groups was compared and the readmission rate of the discharged patients was compared.Results:1 treatment of a course of treatment,the same amount of activity in the case,the treatment group of 13 people,the control group of 9 people with angina pectoris frequency significantly reduced> 90%,angina pain was significantly lower than before,each duration longer than before Significantly shortened,and do not need oral nitroglycerin,after the symptoms gradually ease.Three patients in the treatment group were recurrent without angina during hospitalization.The number of angina pectoris decreased by about 60%-75% before the attack,still need to take a small amount of oral nitroglycerin treatment group of 20 people,the control group of 15 people.There were 2 inthe treatment group and 11 in the control group after treatment.Compared with the control group,the amount of nitroglycerin in the treatment group was significantly lower than that in the control group,but the frequency of angina pectoris was significantly lower than that of the control group.The degree of angina pectoris was significantly higher in the treatment group than in the control group(P<0.05).There was a clear statistical difference.2 After treatment,the degree of ST segment depression in the two groups of patients was relieved,but the recovery of ST in the treatment group was significantly higher than that in the control group.The efficacy of the treatment group was better than that of the control group(P<0.05),and the total time of ST segment depression in 24-hour ambulatory electrocardiogram was reduced and shortened P<0.05),which was statistically significant.3 The observed heart rate variability index was the standard deviation(SDNN)of the normal RR interval of 24 hours,and the standard deviation(SDANN)of the normal RR interval every 5 minutes.The A group after the treatment of SDNN and SDANN were significantly improved,and the difference was statistically significant(P<0.05),B group after treatment of SDNN P 0.853,SDANN P 0.6833,P value was less than 0.05,not statistically significant,indicating that the treatment group significantly improved heart rate variability.4 Heart function improvement after 14 days of treatment,the treatment group left ventricular ejection fraction(LVEF%)and cardiac output(CO L/min)was significantly increased compared with before treatment,the plasma BNP decreased significantly better than the control group,there was significant difference between two groups(P<0.05),cardiac function in the treatment group than the control group significant improvement.Conclusion: In the basic treatment of coronary heart disease while adding alprostadil injection can significantly improve the elderly patients with coronary heart disease,reduce the symptoms of angina,reduce the number of angina pectoris,but also improve the heart rate variability,and no significant adverse Response,is a safe and effective treatment of drugs,worthy of ourwidely used in elderly patients with coronary heart disease myocardial ischemia treatment. |
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