王彦华

【摘要】 目的 探究老年重癥心力衰竭急诊内科治疗的临床方案和疗效。方法 100例老年重症心力衰竭患者作为研究对象， 随机分为观察组和对照组， 每组50例。对照组患者给予急诊内科常规治疗， 观察组患者在急诊内科常规治疗基础上口服厄贝沙坦氢氯噻嗪和美托洛尔治疗。随访1年， 比较两组患者的临床疗效、治疗前后左心室射血分数（LVEF）及B型脑钠肽（BNP）情况、不良反应发生率、复发率和死亡率。结果 观察组总有效率96%高于对照组的78%， 差异具有统计学意义（P<0.05）。观察组治疗后LVEF（49.5±8.6）%高于对照组的（42.0±6.9）%， BNP（795.69±69.35）ng/L低于对照组的（921.98±84.56）ng/L，

差异均具有统计学意义（P<0.05）。观察组复发2例， 占比4% ， 死亡1例， 占比2%；对照组复发13例， 占比26% ， 死亡11例， 占比22%；观察组复发率、死亡率均低于对照组， 差异具有统计学意义（P<0.05）。对照组不良反应发生2例， 观察组不良反应发生1例， 组间比较差异无统计学意义（P>0.05）。结论 老年重症心力衰竭患者在急诊内科常规治疗基础上口服厄贝沙坦氢氯噻嗪和美托洛尔进行治疗， 能够有效改善患者的心功能， 且不良反应发生率低， 安全性较高， 同时复发率及死亡率低， 能够有效改善预后， 值得临床广泛应用。

【关键词】 重症心力衰竭；急诊科；厄贝沙坦氢氯噻嗪；美托洛尔；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

重症心力衰竭是急诊科临床较为常见的由多种因素引发的心功能障碍综合征， 其常表现為心肌梗死、心肌炎等心脏疾病， 临床症状和患者体征多表现为疲乏、呼吸困难、喘息等[1]。老年重症心力衰竭急诊内科的常规治疗药物以强心

剂、利尿剂为主[2-6]。本次研究在常规治疗方法上给予患者口服厄贝沙坦氢氯噻嗪和美托洛尔治疗， 探究治疗方案的临床疗效， 报告如下。

1 资料与方法

1. 1 一般资料 选取2015年11月～2017年5月本院收治的急诊科100例老年重症心力衰竭患者， 随机分为观察组和对照组， 每组50例。……