Sidorowicz Krystyna, Tkacz Ewaryst, Poloński Lech
III Katedra i Oddział Kliniczny Kardiologii Sl. AM, Zabrzu.
Pol Merkur Lekarski. 2002 Jan;12(67):30-5.
Patients with severe systolic heart left ventricle dysfunction determine a group loaded by high mortality. Continuous search for prognostic factors as well as treatment methods influencing a prognosis coming from clinical effects of applied prescriptions and survival in the mentioned group of patients can be observed in many published reports. In the presented work a retrospective analysis has been performed with regard to 106 patients with severe heart lesion: 72 cases with ischaemic disease, 20 cases with post-inflammation heart lesion, 7 cases with hypertension and 7 cases with idiopathic congestive cardiomyopathy. The main criterion including particular patient into the group under analysis was less or equal to 30% ejection fraction confirmed by echocardiographical examination and generally understand heart insufficiency in the clinical examination and laboratory tests. The observation period concerning patients qualified to the analyzed group incorporated 36 +/- 16.5 months. Influence of the parameters obtained from clinical, electrocardiographical, Holter monitoring, chest X-Ray, and serum concentration of both sodium (Na) and potassium (K) have been analyzed. Also the survival analysis has been performed for patients treated: according standard procedures, with addition of beta-adrenolytic drug, with addition of amiodaron, with addition of combination of both beta-adrenolytic drug and amiodaron. During the observation 64 patients have died (60%), 4 patients have had heart transplantation (Htx) performed (4%) and 38 patients survived without necessity of Htx (36%). Among investigated parameters there were following ones which proved their statistical significance in terms of prognosis evaluation: ejection fraction, features of pulmonary haemostasis, HR (heart rate), SBP (systolic blood pressure), serum concentration of both sodium (Na) and potassium (K). Much better therapy effects as well as longer survival have concerned patients with hypertension disease confirmed during the anamnesis. Comparison of the survival curves referring to the patients treated according to different schemes a positive trend in the direction of survival improvement has been observed. This trend however appeared in the group treated additionally with beta-blocker and only in the outpatient follow-up. On the other hand a combination of both beta-blocker and amiodaron has been connected with improved both early and outpatient follow-up survival. The survival curves for patients treated with amiodaron only has been quite similar as in the case of patients treated according standard procedures. Addition of beta-adrenolytic drug or amiodaron or eventually both of these medicines has a significant influence into decrease of repeated hospitalizations in the group under investigation.
重度收缩性左心室功能不全的患者构成了一个高死亡率群体。许多已发表的报告中都在不断探寻预后因素以及影响预后的治疗方法，这些因素和方法源于所应用处方的临床效果以及上述患者群体的生存率。在本研究中，对106例严重心脏病变患者进行了回顾性分析：72例缺血性疾病患者，20例炎症后心脏病变患者，7例高血压患者以及7例特发性充血性心肌病患者。将特定患者纳入分析组的主要标准是经超声心动图检查证实射血分数小于或等于30%，并且在临床检查和实验室检查中普遍存在心脏功能不全。符合分析组条件的患者观察期为36±16.5个月。分析了从临床、心电图、动态心电图监测、胸部X光以及血清钠（Na）和钾（K）浓度获得的参数的影响。还对接受以下治疗的患者进行了生存分析：按照标准程序治疗、加用β-肾上腺素能阻滞剂、加用胺碘酮、加用β-肾上腺素能阻滞剂和胺碘酮的联合治疗。观察期间，64例患者死亡（60%），4例患者接受了心脏移植（Htx）（4%），38例患者存活且无需进行Htx（36%）。在研究的参数中，以下参数在预后评估方面具有统计学意义：射血分数、肺止血特征、心率（HR）、收缩压（SBP）、血清钠（Na）和钾（K）浓度。有既往高血压疾病史的患者治疗效果更好且生存期更长。比较不同治疗方案患者的生存曲线，观察到生存改善方向呈积极趋势。然而，这种趋势仅出现在加用β受体阻滞剂治疗的组中，且仅在门诊随访中出现。另一方面，β受体阻滞剂和胺碘酮的联合应用与早期和门诊随访生存率的提高相关。仅用胺碘酮治疗的患者生存曲线与按标准程序治疗的患者相当相似。加用β-肾上腺素能药物或胺碘酮或最终同时加用这两种药物对减少研究组的再次住院有显著影响。
