奧扎格雷鈉治療冠心病心力衰竭的臨床觀察

董美珍??金麗英

[摘要] 目的 觀察奧扎格雷鈉治療冠心病慢性心力衰竭的療效。 方法 冠心病慢性心力衰竭患者60例，隨機分為對照組30例和治療組30例。對照組給予常規治療，治療組在常規治療的基礎上，加0.9%氯化鈉250mL+奧扎格雷鈉80mg，靜脈滴注，每日1次，連續10d。分別觀察用藥前及用藥10d后兩組患者臨床癥狀、N-端腦利鈉肽前體（NT-proBNP）以及 6min步行距離。 結果 治療10d后，治療組患者6min步行距離明顯延長，與對照組比較差異有統計學意義（P<0.05）。對照組及治療組N-端腦利鈉肽前體水平較治療前均降低（P<0.01或 P<0.05），但治療組血漿N-端腦利鈉肽前體水平降低及心功能改善更顯著（P<0.01）。 結論 奧扎格雷鈉可顯著改善冠心病慢性心力衰竭患者的臨床心功能分級，治療效果確切，安全性好。

[關鍵詞] 奧扎格雷鈉;冠心病;心力衰竭;腦利鈉肽

[中圖分類號] R541.4 [文獻標識碼] B [文章編號] 2095-0616（2015）02-53-03

The therapeutic effects of ozagrel sodium injection on chronic heart failure caused by coronary heart disease

DONG Meizhen JIN Liying

Institute of Cerebrovascular Diseases， Affiliated Hospital of Qingdao University， Qingdao 266003， China

[Abstract] Objective To investigate the therapeutic effect of ozagrel sodium on cardiac function in patients with chronic heart failure caused by coronary heart disease. Methods Total of 60 patients with chronic congestive heart failure caused by coronary heart disease who were admitted into Shandong University Qilu Hospital Qingdao area from Nov.2012 to Oct.2013. All patients were randomly divided into control group and treatment group consisting 30 cases respectively. The patients in control group were treated with routine curse while those in the treatment group were treated with routine curse combined with ozagrel sodium injection （ozagrel sodium injection， 80mg， qd） for 10 days. After treatment for 10 days， the six minutes walk test was measured using the method proposed by Bittner. The serum level of NT-BNP was detected by enzyme linked immunoassay. Results After 10 days treated with ozagrel sodium injection， exercise tolerance of treatment group improved （P<0.05）， while NT-BNP average level lowered， which were all significant （P<0.01）. Conclusion Ozagrel sodium could improve heart function and exercise tolerance in patients with ischemic cardiomyopathy with a exact and safe therapeutic effect.

[Key words] Ozagrel sodium; Coronary heart disease; Chronic heart failure; BNP

心力衰竭（hearth failure，HF）是各種心臟病發展的最終階段。其中約2/3的心力衰竭患者存在冠狀動脈疾病（coronary artery disease，CAD）。因心力衰竭住院的主要病因是冠心病，占57.1%，而冠心病導致的心力衰竭在老年患者更多見，是冠心病的主要死因，約占冠心病死亡比例的40%左右[1]。心力衰竭時，心房心室擴張，心肌缺血缺氧、腎臟缺血和腎功能不全，均可刺激腦利鈉肽（brain natriuretic peptide，BNP）的分泌。腦利鈉肽是機體內在的腎素-血管緊張素-醛固酮系統的拮抗劑，可以抵抗血管的平滑肌細胞、心肌細胞、心纖維原細胞所分泌的的內皮素、去甲腎上腺素和醛固酮等。腦利鈉肽還參與了血壓、血容量以及水鹽平衡的調節，降低體循環血管阻力及血漿容量，從而降低了心臟前、后負荷，并增加心輸出量[2]。研究表明，奧扎格雷鈉（ozagrel sodium）通過高選擇性的抑制血栓素合成酶（TXA），促進前列腺素（PGI）的合成，提高PGI/TXA比例，促進冠脈擴張，增加血流，增加心肌的供血供氧[3-6]。本研究應用奧扎格雷鈉治療30例冠心病心衰患者，收到了較好的療效，現報道如下。endprint