标题：缬沙坦联合左卡尼汀治疗慢性肾衰竭血液透析伴心力衰竭对患者心肾功能的影响

      作者：冯玲，梁维，赵静，何志婷，许晓丽    西安市第九医院肾脏内科，陕西 西安 710054

      卷次： 2022年33卷9期

      【摘要】 目的 探讨缬沙坦联合左卡尼汀治疗慢性肾衰竭血液透析伴心力衰竭对患者心肾功能的影响。方法 选取 2018年12月至2020年12月在西安市第九医院确诊的120例慢性肾衰竭血液透析伴心力衰竭患者，采用随机数表法将患者分为观察组和对照组，每组60例。两组患者均接受血液透析治疗，在此基础上对照组患者应用左卡尼汀治疗，观察组患者采用缬沙坦联合左卡尼汀治疗，均持续治疗3个月。比较两组患者的治疗效果以及治疗前后的心输出量(CO)、心脏指数(CI)、中心静脉压(CVP)、心机耗氧量(MVO)、有效循环血量(ECV)、射血分数(EF)、左室舒张内径(LVEDD)、收缩末期内径(LVESD)、左室后壁厚度(LVPWT)、左室射血分数(LVEF)和尿素氮(BUN)、血肌酐(Scr)、血清肿瘤坏死因子-α (TNF-α)、超敏C反应蛋白(hs-CRP)水平，同时比较两组患者的不良反应发生情况。结果 治疗3 个月后，观察组患者的治疗总有效率为 86.67%，明显高于对照组的 70.00%，差异有统计学意义(P<0.05)；与治疗前比较，治疗后两组患者的CO、CI、CVP、MVO、ECV、LVEDD、LVESD和LVPWT指标均下降，EF和LVEF指标升高，且观察组患者的CO、CI、CVP、MVO、ECV、LVEDD、LVESD和LVPWT明显低于对照组，EF和 LVEF明显高于对照组，差异均有统计学意义(P<0.05)；与治疗前比较，治疗后，两组患者的 BUN、Scr、TNF-α、hs-CRP水平均降低，且观察组患者BUN、Scr、TNF-α和hs-CRP水平明显低于对照组，差异均有统计学意义(P<0.05)。治疗期间，观察组患者的不良反应总发生率为6.67%，明显低于对照组的23.33%，差异有统计学意义(P<0.05)。结论 缬沙坦联合左卡尼汀治疗可以明显提高慢性肾衰竭血液透析伴心力衰竭患者的临床疗效，且对心肾功能的影响明显降低。
      【关键词】 慢性肾衰竭；血液透析；心力衰竭；缬沙坦；左卡尼汀；疗效
      【中图分类号】 R692.5 【文献标识码】 A 【文章编号】 1003—6350（2022）09—1122—04

Effects of valsartan combined with levocarnitine on heart-kidney function of patients with chronic renal failureand heart failure undergoing hemodialysis.
FENG Ling, LIANG Wei, ZHAO Jing, HE Zhi-ting, XU Xiao-li. Departmentof Nephrology, Xi'an Ninth Hospital, Xi'an 710054, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of valsartan combined with levocarnitine on heart-kidney functionof patients with chronic renal failure and heart failure undergoing hemodialysis. Methods A total of 120 patients con-firmed with chronic renal failure and heart failure undergoing hemodialysis in Xi'an Ninth Hospital were enrolled be-tween December 2018 and December 2020. According to random number table method, they were divided into an obser-vation group and a control group, with 60 patients in each group. Based on hemodialysis, patients in the control groupwere treated with levocarnitine, while those in the observation group were treated with valsartan combined with levocar-nitine, continuously for 3 months. The curative effect, cardiac function indexes [cardiac output (CO), cardiac index (CI),central venous pressure (CVP), myocardial oxygen consumption (MVO), effective circulating volume (ECV), ejectionfraction (EF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ven-tricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF)], blood urea nitrogen (BUN), andcreatinine (Scr), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) were compared be-tween the two groups. Results After 3 months of treatment, the total effective rate of treatment in the observationgroup was significantly higher than that in control group (86.67% vs 70.00%, P<0.05). After 3 months of treatment, CO,CI, CVP, MVO, ECV, LVEDD, LVESD, and LVPWT in the observation group were significantly lower than those incontrol group, while EF and LVEF were significantly higher than those in the control group (P<0.05). After 3 months oftreatment, the levels of BUN, Scr, TNF-α, and hs-CRP in the observation group were significantly lower than those inthe control group (P<0.05), and incidence of adverse reactions was significantly lower than that in the control group(6.67% vs 23.33%, P<0.05). Conclusion Valsartan combined with levocarnitine can significantly improve the clinicalcurative effect on patients with chronic renal failure and heart failure undergoing hemodialysis. The effects of the com-bined therapy on heart-kidney function are significantly fewer.
      【Key words】 Chronic renal failure; Hemodialysis; Heart failure; Valsartan; Levocarnitine; Curative effect