伊伐布雷定联合连续床旁血液净化对尿毒症合并急性左心衰患者的影响

Efficacy of ivabradine combined with continuous bedside blood purification in treating patients with uremia complicated by acute left heart failure

摘要:

目的 探究伊伐布雷定联合连续床旁血液净化对尿毒症合并急性左心衰患者的影响。方法 选取2018年5月—2023年1月武汉市第三医院重症医学科收治的尿毒症合并急性左心衰患者102例，按随机数字表法分为观察组和对照组，每组51例。对照组行连续床旁血液净化，观察组在对照组基础上口服伊伐布雷定。对比两组疗效、血液生物化学指标［尿素氮（BUN）、肌酐（Cr）、血钾（K⁺）、血钠（Na⁺）］、心功能指标［左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）、左室射血分数（LVEF）］、心肌标志物［N末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白T（cTnT）］水平及不良反应。结果 观察组总有效率（94.12%）高于对照组（80.39%）（P <0.05）；观察组治疗前后BUN、Cr、K⁺、Na⁺、收缩压、舒张压、LVEDD、LVESD、LVEF、NT-proBNP、cTnT的差值均高于对照组（P <0.05）。观察组总不良反应发生率（3.92%）低于对照组（15.69%）（P <0.05）。结论 伊伐布雷定联合连续床旁血液净化能有效缓解尿毒症合并急性左心衰患者症状，改善心功能与心肌标志物水平，安全性高。

Abstract:

Objective To explore the efficacy of ivabradine combined with continuous bedside blood purification in treating patients with uremia complicated by acute left heart failure.Methods A total of 102 patients with uremia combined by acute left heart failure admitted to the Department of Critical Care Medicine of Wuhan Third Hospital from May 2018 to January 2023 were selected. They were divided into the observation group and the control group with the random number table method, with 51 cases in each group. The control group received continuous bedside blood purification, and the observation group was additionally treated with oral ivabradine. The therapeutic effect, blood biochemical indicators [blood urea nitrogen (BUN), creatinine (Cr), potassium (K⁺) and sodium (Na⁺)], cardiac function indicators [left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular ejection fraction (LVEF)], cardiac markers [N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT)] and adverse reactions were compared between the two groups.Results The overall effective rate of the observation group (94.12%) was higher than that of the control group (80.39%) (P < 0.05). The differences of levels of BUN, Cr, K⁺, and Na⁺, systolic blood pressure, diastolic blood pressure, LVEDD, LVESD, LVEF, and levels of NT-proBNP and cTnT before and after treatment in the observation group were higher than those in the control group (P < 0.05). The incidence of adverse reactions in the observation group (3.92%) was lower than that in the control group (15.69%) (P < 0.05).Conclusions Ivabradine combined with continuous bedside blood purification can effectively relieve the symptoms of patients with uremia complicated by acute left heart failure, and improve cardiac function and levels of cardiac markers with a good safety profile.