2020 年第 5 期 第 15 卷

小剂量地高辛联合美托洛尔对应用低分子肝素的老年慢性心力衰竭伴心房颤动患者凝血功能的影响

Effect of low dose digoxin combined with metoprolol on coagulation function in elderly patients with chronic heart failure and atrial fibrillation treated with low molecular weight heparin 

作者：赵倩；刘鹏园；陈秀秀；李书英；王占坤；王梦梦；杨学敏?响

英文作者：Zhao Qian Liu Pengyuan Chen Xiuxiu Li Shuying Wang Zhankun Wang Mengmeng Yang Xuemin 

单位：河北省保定市第二中心医院药剂科072750

英文单位：Department of Pharmacy Baoding Second Central Hospital Heibei Province Baoding 072750 China

关键词：慢性心力衰竭；心房颤动；地高辛；美托洛尔；低分子肝素；凝血功能

英文关键词：ObjectiveToinvestigatetheeffectoflowdosedigoxincombinedwithmetoprololoncoagulationfunction,cardiacfunctionandmyocardialenzymespectruminelderlypatientswithchronicheartfailure(CHF)andatrialfibrillationtreatedwithlowmolecularweightheparin.MethodsFromJanuary2017toJanuary2019,130elderlyCHFpatientswithatrialfibrillationadmittedtotheBaodingSecondCentralHospital,HebeiProvincewererandomlydividedintocontrolgroupandobservationgroup,with65casesineachgroup.Thecontrolgroupweregivenmetoprololsustained-releasetabletsonthebasisofroutinetreatmentandtheobservationgroupweregivenmetoprololplusdigoxinonthebasisofcontrdgroup.Clinicalefficacywasobserved8weeksaftertreatment.Thrombintime,prothrombintime,leftventricularend-diastolicdiameter,leftventricularend-systolicdiameter,leftventricularejectionfraction,serumlactatedehydrogenase,creatinekinaseandcreatinekinaseisoenzymewereanalyzed.ResultsTotaleffectiverateinobservationgroupwassignificantlyhigherthanthatincontrolgroup［95.4%(62/65)vs78.5%(51/65),P＜0.05］.Therewerenosignificantdifferencesinprothrombintimebetweengroupsbeforeandaftertreatment(P>0.05).Cardiacfunctionandmyocardialenzymespectrumshowednostatisticaldifferencesbetweengroupsbeforetreatment(P>0.05).Aftertreatment,leftventricularend-diastolicdiameter,leftventricularend-systolicdiameter,levelsofserumlactatedehydrogenase,creatinekinaseandcreatinekinaseisoenzymeweresignificantlyreducedandtheindexesinobservationgroupwereless/lowerthanthoseincontrolgroup［(50±6)mmvs(55±7)mm,(39±4)mmvs(41±3)mm,(160±21)U/Lvs(205±18)U/L,(160±17)U/Lvs(176±15)U/L,(19±5)U/Lvs(33±4）U/L］;leftventricularejectionfractionincreasedaftertreatmentanditwashigherinobservationgroupthancontrolgroup［(49±5)%vs(46±4)%］(allP＜0.05).ConclusionLowdosedigoxincombinedwithmetoprololiseffectiveintreatmentofCHFwithatrialfibrillationinelderlypatients.Cardiacfunctionandmyocardialenzymeindexescanbeimprovedandnoadversereactionfromcoagulationisobserved.

• 摘要：

• 目的 探讨小剂量地高辛联合美托洛尔对应用低分子肝素的老年慢性心力衰竭（CHF）伴心房颤动患者凝血功能、心功能和心肌酶谱的影响。方法 选取河北省保定市第二中心医院2017年1月至2019年1月收治的老年CHF伴心房颤动患者130例。应用随机数字表法分为对照组和观察组，各65例。对照组在常规治疗基础上口服美托洛尔缓释片治疗，观察组在对照组治疗基础上联合地高辛治疗，比较2组患者治疗30 d后的临床疗效，治疗前后活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、左心室舒张末期内径、左心室收缩末期内径、左心室射血分数和血清乳酸脱氢酶、肌酸激酶及肌酸激酶同工酶水平。结果 治疗30 d后，观察组总有效率高于对照组［95.4%（62/65）比78.5%（51/65）］（P＜0.05）。治疗前后，2组患者的活化部分凝血活酶时间、凝血酶原时间、凝血酶时间水平比较差异均无统计学意义（均P＞0.05）。治疗前，2组患者的心功能和心肌酶谱指标水平比较差异均无统计学意义（均P＞0.05）。治疗后 2组患者的左心室舒张末期内径、左心室收缩末期内径和血清乳酸脱氢酶、肌酸激酶及肌酸激酶同工酶水平均小于/低于治疗前，且观察组低于对照组［(50±6)mm比（55±7）mm、（39±4）mm比（41±3）mm、(160±21)U/L比（205±18）U/L、（160±17）U/L比（176±15）U/L、（19±5）U/L比（33±4）U/L］，左心室射血分数均高于治疗前，且观察组高于对照组［(49±5)%比（46±4）%］（均P＜0.05）。结论小剂量地高辛联合美托洛尔治疗应用低分子肝素的老年CHF伴心房颤动患者临床疗效显著，心功能和心肌酶谱指标改善明显，且不影响凝血功能。