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目的观察硝普钠联合多巴酚丁胺治疗急性心力衰竭患者的临床效果及对肾功能的影响。方法选取医院收治的急性心力衰竭患者160例为研究对象,随机分为观察组和对照组,每组80例。2组均给予常规治疗,包括利尿、强心、抗感染及扩张血管等。对照组同时给予硝普钠治疗,观察组在对照组治疗基础上加用多巴酚丁胺治疗。观察2组临床疗效;治疗前后收缩压、舒张压、心排血指数及心率变化情况;左心室射血分数、6 min最大步行距离和每搏输出量及不良反应发生情况。结果观察组总有效率为96.3%,显著高于对照组的76.3%(P<0.01)。治疗前2组收缩压、舒张压、心排血指数及心率比较差异均无统计学意义(P>0.05);治疗后,观察组收缩压、舒张压及心排血指数均优于对照组(P<0.01),心率低于对照组(P<0.01)。治疗前,2组左心室射血分数、6 min最大步行距离和每搏输出量比较差异均无统计学意义(P>0.05);治疗后,观察组左心室射血分数、6 min最大步行距离和每搏输出量均高于对照组(P<0.05)。与治疗前比较,治疗后2组患者24 h尿量、尿素氮和血肌酐升高(P<0.05或P<0.01)。2组患者均未出现明显不良反应。结论硝普钠联合多巴酚丁胺可显著改善心力衰竭患者的心功能,对肾功能影响较小,安全性较高。
Objective To observe the clinical effects of sodium nitroprusside combined with dobutamine on patients with acute heart failure and its effect on renal function. Methods A total of 160 acute heart failure patients admitted to hospital were selected as study subjects and randomly divided into observation group and control group, 80 cases in each group. Both groups were given routine treatment, including diuresis, cardiac, anti-infection and dilatation of blood vessels. The control group was treated with sodium nitroprusside at the same time. The observation group was treated with dobutamine in the control group. The clinical curative effect of the two groups were observed. The changes of systolic blood pressure, diastolic blood pressure, cardiac output index and heart rate were observed before and after treatment. The left ventricular ejection fraction, the maximum walking distance at 6 min, the stroke volume and the incidence of adverse reactions were observed. Results The total effective rate in the observation group was 96.3%, which was significantly higher than that in the control group (76.3%, P <0.01). There were no significant differences in systolic blood pressure, diastolic blood pressure, cardiac output index and heart rate between the two groups before treatment (P> 0.05). After treatment, systolic blood pressure, diastolic blood pressure and cardiac output index were all better than those in the control group P <0.01), heart rate was lower than that of the control group (P <0.01). Before treatment, there was no significant difference in left ventricular ejection fraction, maximum walking distance at 6 min and stroke volume (P> 0.05). After treatment, the left ventricular ejection fraction, the maximum walking distance of 6 min And stroke volume were higher than the control group (P <0.05). Compared with those before treatment, 24 h urinary output, urea nitrogen and serum creatinine were increased in both groups after treatment (P <0.05 or P <0.01). No significant adverse reactions occurred in both groups. Conclusion Sodium nitroprusside combined with dobutamine can significantly improve cardiac function in patients with heart failure, renal function less affected, higher safety.