摘要
目的 探讨常规急救方案联合灯盏生脉饮治疗急性心力衰竭(AHF)合并糖尿病患者的疗效及对血气指标、心功能和糖脂代谢的影响.方法 回顾性选取2021年9月至2022年12月首都医科大学附属北京同仁医院收治的AHF合并糖尿病患者80例作为研究对象,按治疗方法不同将患者分为观察组与对照组,每组各40例.对照组患者采取常规急救方案,如无创呼吸机、硝普钠、多巴胺治疗等,观察组患者在对照组基础上给予灯盏生脉饮治疗,两组均治疗20 d.比较两组患者急救效果,并比较两组患者的治疗前、治疗后1 d的血气指标[动脉二氧化碳分压(PaCO2)、动脉氧分压(PaO2)]、氨基末端脑钠素前体(NT-proBNP)水平、心功能[左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、每搏心输出量(SV)]、糖脂代谢[糖化血红蛋白(GHb)、空腹血糖(FPG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平及不良反应.结果 观察组患者急救总有效率为92.50％,显著高于对照组(77.50％),差异有统计学意义(P＜0.05).观察组患者治疗后1 d的PaO2为(75.23±7.98)mmHg,显著高于对照组[(61.23±7.31)mmHg],PaCO2、NT-proBNP 水平分别为(37.38±6.89)mmHg、(529.63±189.74)pg/mL,均显著低于对照组[(46.13±7.07)mmHg、(695.45±263.32)pg/mL],差异均有统计学意义(P＜0.05).观察组患者治疗后 1 d 的 LVESV、LVEDV、SV 分别为(109.71±9.65)、(173.48±18.72)、(79.77±9.32)mL,均低于对照组[(130.45±13.53)、(210.75±21.34)、(89.34±9.02)mL],LVEF 为(54.38±6.04)％,显著高于对照组[(45.23±5.49)％],差异均有统计学意义(P＜0.05).观察组 FPG、GHb、LDL-C 水平分别为(6.04±1.01)mmol/L、(6.03±0.94)％、(1.82±0.59)mmol/L,均显著低于对照组[(7.69±1.01)mmol/L、(7.68±0.51)％、(2.82±0.62)mmol/L],HDL-C水平为(3.24±0.21)mmol/L,显著高于对照组[(2.28±0.20)mmol/L],差异均有统计学意义(P＜0.05).对照组与观察组治疗期间不良反应发生率比较(7.50％vs.10.0％),差异无统计学意义(P＞0.05).结论 常规急救方案联合灯盏生脉饮治疗AHF合并糖尿病患者急救效果显著,可更好地改善患者血气指标及心功能,调节患者糖脂代谢指标水平,且具有一定安全性.
Abstract
Objective To explore the efficacy of routine emergency treatment combined with Dengzhan Shengmai Decoction in the treat-ment of patients with acute heart failure(AHF)complicated with diabetes and its effects on blood gas index,cardiac function,glucose and lipid metabolism.Methods A total of 80 patients with AHF complicated with diabetes admitted to Beijing Tongren Hospital,Capital Medical Universi-ty from September 2021 to December 2022 were retrospectively selected as the research objects.According to different treatment methods,the pa-tients were divided into observation group and control group,with 40 cases in each group.The patients in the control group were treated with con-ventional emergency treatment,such as non-invasive ventilator,sodium nitroprusside,dopamine treatment,etc.The patients in the observation group were treated with Dengzhan Shengmai Decoction on the basis of the control group.Both groups were treated for 20 days.The first aid effects of the two groups were compared.The blood gas indexes[arterial carbon dioxide partial pressure(PaCO2),arterial oxygen partial pressure(PaO2)],N-terminal pro-brain natriuretic peptide(NT-proBNP)level,cardiac function[left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),stroke volume(SV)],glucose and lipid metabolism[glycosylated hemoglobin(GHb),fasting blood glucose(FPG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein choles-terol(HDL-C)]levels before treatment and 1 d after treatment and adverse reactions were compared between the two groups.Results The to-tal effective rate of emergency treatment in the observation group was 92.50％,which was significantly higher than that in the control group(77.50％),the difference was statistically significant(P＜0.05).After 1 day of treatment,the PaO2 of the observation group was(75.23±7.98)mmHg,which was significantly higher than that of the control group[(61.23±7.31)mmHg],the levels of PaCO2 and NT-proBNP in the observation group were(37.38±6.89)mmHg and(529.63±189.74)pg/mL,respectively,which were significantly lower than those in the control group[(46.13±7.07)mmHg and(695.45±263.32)pg/mL],and the differences were statistically significant(P＜0.05).After 1 day of treatment,the LVESV,LVEDV,and SV of the observation group were(109.71±9.65),(173.48±18.72),and(79.77±9.32)mL,respectively,which were lower than those of the control group[(130.45±13.53),(210.75±21.34),and(89.34±9.02)mL],the LVEF was(54.38±6.04)％,which was significantly higher than that of the control group[(45.23±5.49)％],and the differences were statistically significant(P＜0.05).The levels of FPG,GHb,and LDL-C in the observation group were(6.04±1.01)mmol/L,(6.03±0.94)％,and(1.82±0.59)mmol/L,respectively,which were significantly lower than those in the control group[(7.69±1.01)mmol/L,(7.68±0.51)％,and(2.82±0.62)mmol/L],while the level of HDL-C was(3.24±0.21)mmol/L,which was significantly higher than that in the control group[(2.28±0.20)mmol/L],and the differences were statistically significant(P＜0.05).The incidence of adverse reactions during treat-ment was compared between the control group and the observation group(7.50％vs.10.0％),and the difference was not statistically significant(P＞0.05).Conclusion Conventional emergency treatment combined with Dengzhan Shengmai Decoction has a significant emergency effect in the treatment of patients with acute heart failure complicated with diabetes,which can better improve the blood gas index and cardiac function of patients,regulate the level of glucose and lipid metabolism index of patients,and has certain safety.
基金项目
北京市通州区科技计划项目(KJ2014CX007-12)
NETL
NSTL
万方数据