老年重癥心力衰竭急診內科治療的臨床研究

王彥華

【摘要】 目的 探究老年重癥心力衰竭急診內科治療的臨床方案和療效。方法 100例老年重癥心力衰竭患者作為研究對象， 隨機分為觀察組和對照組， 每組50例。對照組患者給予急診內科常規治療， 觀察組患者在急診內科常規治療基礎上口服厄貝沙坦氫氯噻嗪和美托洛爾治療。隨訪1年， 比較兩組患者的臨床療效、治療前后左心室射血分數（LVEF）及B型腦鈉肽（BNP）情況、不良反應發生率、復發率和死亡率。結果 觀察組總有效率96%高于對照組的78%， 差異具有統計學意義（P<0.05）。觀察組治療后LVEF（49.5±8.6）%高于對照組的（42.0±6.9）%， BNP（795.69±69.35）ng/L低于對照組的（921.98±84.56）ng/L，

差異均具有統計學意義（P<0.05）。觀察組復發2例， 占比4% ， 死亡1例， 占比2%；對照組復發13例， 占比26% ， 死亡11例， 占比22%；觀察組復發率、死亡率均低于對照組， 差異具有統計學意義（P<0.05）。對照組不良反應發生2例， 觀察組不良反應發生1例， 組間比較差異無統計學意義（P>0.05）。結論 老年重癥心力衰竭患者在急診內科常規治療基礎上口服厄貝沙坦氫氯噻嗪和美托洛爾進行治療， 能夠有效改善患者的心功能， 且不良反應發生率低， 安全性較高， 同時復發率及死亡率低， 能夠有效改善預后， 值得臨床廣泛應用。

【關鍵詞】 重癥心力衰竭；急診科；厄貝沙坦氫氯噻嗪；美托洛爾；老年

DOI：10.14163/j.cnki.11-5547/r.2018.02.043

Clinical study on the treatment of senile severe heart failure in emergency internal medicine department WANG Yan-hua. Department of Internal Medicine-Cardiovascular， Jilin Oil Field General Hospital， Songyuan 138000， China

【Abstract】 Objective To discuss the clinical regimen and efficacy of senile severe heart failure in emergency internal medicine department. Methods A total of 110 senile patients with severe heart failure were randomly divided into observation group and control group， with 50 cases in each group. The control group received conventional therapy of emergency internal medicine department， and the observation group received oral irbesartan and hydrochlorothiazide and metoprolol on the basis of conventional therapy of emergency internal medicine department. After 1-year follow-up， comparison were made on clinical efficacy， left ventricular ejection fraction （LVEF） and B type natriuretic peptide （BNP） before and after treatment， incidence of adverse reaction， recurrence rate and mortality rate between two groups. Results The observation group had higher total effective rate as 96% than 78% in the control group， and the difference was statistically significant （P<0.05）. The observation group had higher LVEF after treatment as （49.5±8.6）% than （42.0±6.9）% in the control group， and lower BNP as （795.69±69.35） ng/L than （921.98±84.56） ng/L in the control group. Their difference was statistically significant （P<0.05）. The observation group had 2 recurrent cases， accounting for 4% and 1 death case， accounting for 2%， while the control group had 13 recurrent cases， accounting for 26% and 11 death cases， accounting for 22%. The observation group had lower recurrence rate and mortality rate than the control group， and their difference was statistically significant （P<0.05）. The control group had 2 cases with adverse reactions， while the control group had 1 case with adverse reactions， but their difference was not statistically significant （P>0.05）. Conclusion Oral irbesartan and hydrochlorothiazide and metoprolol for senile patients with severe heart failure on the basis of conventional therapy of emergency internal medicine department， can effectively improve the patient's heart function with low incidence of adverse reactions and high safety， along with low recurrence rate and mortality rate. It also can effectively improve the prognosis， and is worthy of wide clinical application.endprint

【Key words】 Severe heart failure； Emergency department； Irbesartan and hydrochlorothiazide； Metoprolol； Senile

重癥心力衰竭是急診科臨床較為常見的由多種因素引發的心功能障礙綜合征， 其常表現為心肌梗死、心肌炎等心臟疾病， 臨床癥狀和患者體征多表現為疲乏、呼吸困難、喘息等[1]。老年重癥心力衰竭急診內科的常規治療藥物以強心

劑、利尿劑為主[2-6]。本次研究在常規治療方法上給予患者口服厄貝沙坦氫氯噻嗪和美托洛爾治療， 探究治療方案的臨床療效， 報告如下。

1 資料與方法

1. 1 一般資料 選取2015年11月～2017年5月本院收治的急診科100例老年重癥心力衰竭患者， 隨機分為觀察組和對照組， 每組50例。……