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目的:探讨重组人促红素(EPO)联合米多君对终末期心力衰竭患者心功能及血流动力学的影响。方法:将43例终末期心力衰竭患者随机分为联合治疗组(n=22)与对照组(n=21),两组均接受规范的慢性充血性心力衰竭药物治疗,联合治疗组在此治疗基础上再给予EPO(4 000 IU/次,皮下注射,每周2次)、多糖铁复合物胶囊(150 mg,每日3次)及米多君(2.5mg,每日2次)。随访3个月,分别于治疗前及随访期结束时行血压、血常规、脑钠肽、心脏彩色多普勒超声及平均肺动脉压(mPAP)检查,并记录两组患者心血管事件发生率。结果:随访结束时,与对照组比较,联合治疗组血浆血红蛋白、收缩压、舒张压明显升高,血浆脑钠肽水平及因心力衰竭再次住院率明显降低,两组比较差异有统计学意义(P<0.05);两组的mPAP及LVEF比较差异无统计学意义(P﹥0.05)。结论:在慢性充血性心力衰竭规范治疗基础上,终末期心力衰竭患者加用EPO及米多君可改善心功能及血流动力学。
Objective: To investigate the effect of recombinant human erythropoietin (EPO) combined with midodrine on cardiac function and hemodynamics in patients with end-stage heart failure. Methods: Forty-three patients with end-stage heart failure were randomly divided into the treatment group (n = 22) and the control group (n = 21). The two groups were given standard chronic congestive heart failure drug treatment. The combination therapy group On the basis of this, EPO (4 000 IU / time, subcutaneously twice a week), polysaccharide iron complex capsules (150 mg three times a day) and midodrine (2.5 mg twice daily) were given. The patients were followed up for 3 months. Blood pressure, blood routine, brain natriuretic peptide, cardiac color Doppler echocardiography and mean pulmonary arterial pressure (mPAP) were recorded before treatment and at the end of the follow-up period respectively. The incidence of cardiovascular events was recorded in both groups. Results: At the end of follow-up, the plasma hemoglobin, systolic blood pressure and diastolic blood pressure were significantly higher in the combined treatment group than those in the control group. The levels of plasma brain natriuretic peptide and rehospitalization due to heart failure were significantly lower, with significant difference between the two groups P <0.05). There was no significant difference in mPAP and LVEF between the two groups (P> 0.05). Conclusion: Based on the standard treatment of chronic congestive heart failure, end-stage heart failure patients with EPO and midodrine can improve cardiac function and hemodynamics.