目的 观察环磷腺苷葡胺联合丹参治疗老年冠心病合并充血性心力衰竭的疗效及对B型利钠肽(B-typy natriuretic peptide,BNP)的影响,并探讨其作用机制.方法 60例老年冠心病合并充血性心力衰竭心功能Ⅲ～Ⅳ级住院患者,随机分为治疗组和对照组,每组30例.对照组在充血性心力衰竭治疗中采用加强休息、限盐、利尿、扩血管、给予血管紧张素转化酶抑制剂等常规治疗,但不使用环磷腺苷葡胺及丹参治疗.治疗组除常规治疗外,环磷腺苷葡胺60～160 mg加入5%葡萄糖注射液250 ml中,丹参注射液20 ml+5%葡萄糖液250 ml静脉滴注,1次/d,静脉滴注,14 d为1疗程.给药前及治疗后分别测定血浆BNP浓度,并观察美国纽约心脏协会心功能改善状况.结果治疗14 d后,治疗组总有效率90.00%,对照组总有效率73.33%,2组差异有统计学意义(P<0.05).2组治疗后BNP和LVEF与治疗前比较,差异有统计学意义(P<0.05或<0.01);2组间比较,差异有统计学意义(P<0.05或<0.01).结论 环磷腺苷葡胺联合丹参是治疗老年冠心病合并充血性心力衰竭有效的药物.%Objective To investigate the effect of meglumine adenosine cyclophosphate combined with Danshen injection on the levels of B-type natriuretic peptide and heart function in elderly patients with coronary heart disease complicated by congestive heart failure. Methods 60 elderly patients with coronary heart disease complicated by congestive heart failure were randomly divided into control group ( n = 30, routine treatment) and treatment group ( n = 30, meglumine adenosine cyclophosphate combined with Danshen injection treatment ), with a treatment course of 14 days for both groups. The BNP levels in plasma, cardiac function including left-ventricular end-diastolic dimension ( LVEDD ) and left-ventricular ejection fraction ( LVEF ) were detected before and after treatment, and the improvement state of patients' cardiac function before and after treatment was observed according to the criteria established by USA New York Heart Association. Results After 14-day treatment, the total effective rate in treatment group was 90. 00% , which was 73. 33% in control group, there was a significant difference between two groups ( P < 0. 05 ). The BNP levels in treatment group were significantly decreased, as compared with those in control group ( P < 0. 01 ). The patients' LVEF and LVEDD were improved in both groups. Conclusion The meglumine adenosine cyclophosphate combined with Danshen injection is effective in treating senile coronary heart disease complicated by congestive heart failure.
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