【摘要】 目的 觀察慢性心力衰竭營養支持治療的療效。 方法 將2007年1月〖CD3/5〗2009年10月期間收治的56例慢性心力衰竭住院患者隨機分為常規治療組及強化營養支持治療組,每組28例患者。其中,強化治療組是在常規治療的基礎上,給與強化營養支持治療。比較兩組治療前后6 min步行距離、NYHA心功能評級及射血分數。 結果 治療后,患者6 min步行距離、心功能評級強化營養治療組優于常規治療組。左心室射血分數兩組無差異。 結論 對慢性心力衰竭患者,營養支持治療是重要的治療手段。【Abstract】 Objective To study the efficacy of nutritional support treatment for chronic heart failure. Methods 56 patients with chronic heart failure hospitalized patients were randomly divided into conventional therapy group and enhanced nutritional support therapy group, 28 patients in each group. Where enhenced therapy group is on the basis of conventional therapy to give extra enhanced intensive nutrition support treatment. Before and after treatment were compared sixminutes walking distance, NYHA cardiac function class, ejection fraction, mortality. Results After treatment, patients with sixminutes walking distance, cardiac function class,enhanced nutritional support therapy group is better than conventional treatment group. Left ventricular ejection fraction was no difference. Conclusion Patients with chronic heart failure, nutritional support treatment is an important treatment.
ObjectiveTo systematically summarize and evaluate the existing evidence of Qishen Yiqi dropping pill (QSYQ) in the treatment of chronic heart failure (CHF), and to evaluate its quality. MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, CNKI, CBM, WanFang Data databases were electronically searched to collect systematic reviews/meta-analyses(SRs/MAs) related to objectives from inception to December 31, 2022. Two researchers independently screened the literature and extracted data, and assessed the methodological quality, risk of bias, reporting quality, and quality of evidence of included SRs/MAs by using Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic(ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. ResultsThis overview included 17 SRs/MAs. The methodological quality, reporting quality, risk of bias, and quality of evidence for outcome measures of SRs/MAs were all unsatisfactory. All SRs/MAs were of low quality according to the results of the AMSTAR-2 assessment. And only a small number of SRs/MAs were assessed as low risk of bias based on the results of the ROBIS assessment. The evaluation results of the PRISMA checklist showed that the report quality of the 24 studies included was relatively complete. According to the GRADE system evaluation results, 94% of the 84 outcome indicators were low-quality and very low-quality evidence. Limitations were the main factors leading to their degradation, followed by publication bias, inconsistency, imprecision and indirectness. ConclusionAt present, QSYQ has good clinical efficacy in the treatment of CHF, but the standardization and scientificity of clinical research and secondary research reports are insufficient, resulting in low quality of clinical recommendations evidence. In the future, it is necessary to further standardize and improve the quality of clinical and secondary research.
ObjectivesTo systematically assess the efficacy and safety of nitrates for patients with chronic heart failure.
MethodWe searched PubMed, EMbase, Web of Science, The Cochrane Library (Issue 1, 2016), CBM, CNKI, VIP, and WanFang Data to collect randomized controlled trials (RCTs) and cross-over studies about nitrates in the treatment of heart failure from inception to January 4th 2016. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.
ResultsTen trials were included involving 414 patients (195 patients in the nitrates group and 219 patients in the control group). The results of meta-analysis showed that, compared with the control group, the nitrates group could reduce arterial blood pressure (MD=-1.91, 95%CI -3.66 to -0.16, P=0.03), pulmonary wedge pressure vessels (PCWP) (MD=-2.00, 95%CI -3.84 to -0.15, P=0.03), increase cardiac index (CI) (MD=0.25, 95%CI 0.09 to 0.42, P=0.003), treadmill exercise time (MD=70.14, 95%CI 55.22 to 85.05, P < 0.000 01); but easily emerge side effects (OR=5.21, 95%CI 2.60 to 10.41, P < 0.000 01).
ConclusionCurrent evidence indicates that nitrates treatment could improve the hemodynamic effect, enhance cardiac output and increase exercise tolerance in patients with heart failure.
The fundamental reason why the organic lesions of chronic heart failure are difficult to reverse is ventricular remodeling. Myocardial fibrosis (MF) is an important pathological basis of ventricular remodeling. Its development process involves complex biological mechanisms and neuroendocrine system. Extracellular signal-regulated kinase (ERK) pathway is a classic pathway for the treatment of tumors. It is found that the inhibition of the ERK pathway can also slow down the progressive aggravation of MF. Therefore, exploring the mechanism of ERK pathway in MF may provide a new idea for the prevention and treatment of chronic heart failure. In this paper, the mechanism of ERK pathway in the occurrence and development of MF and its inhibition drugs were described, in order to provide evidence for the prevention and treatment of MF in chronic heart failure based on this pathway.
摘要:目的:觀察伴有抑郁癥狀的心力衰竭患者加用黛力新干預的療效。方法: 65例用Zung抑郁自評量表檢測評測診斷為抑郁癥并心力衰竭患者,將患者分為黛力新治療組及對照組,治療組在常規治療基礎上加用黛力新(2片/d),治療1個月后再行Zung抑郁自評量表粗分及24項癥狀統計,同時觀察治療前后患者心功能改善情況。結果: 35例治療組患者心功能的改善及Zung抑郁自評量表檢測粗分及24項癥狀改善明顯優于對照組。〖HTH〗結論〖HTSS〗: 黛力新使心衰患者的抑郁癥狀很快得到改善,并提高了心力衰竭的療效。Abstract: Objective: To observe the curative efficacy of deanxit to the patients suffering by heart failure with depression. Methods: Sixtyfive patients who were diagnosed as depression by Zung Selfrating Depression Scale are into deanxit treatment group and control group,and treatment group receive the treatment with two pieces of deanxit everyday besides the conventional therapy.After a month,we count the Zung selfrating depression scale score and study the24 symptoms,at the same time,we observed the change of cardiac function in the patients. Results:The curative efficacy in the treatment group is better than those in the control group with improvement in cardiac function and Zung selfrating depression scale score and the alleviation for 24 symptoms. Conclusion:Deanxit can alleviate symptoms of depression in patients with heart failure soon and increase the efficacy of heart failure.
Objective To cluster the symptoms of patients with chronic heart failure (CHF) through the cluster analysis, and to explore the relationships among symptom clusters of CHF, patients’ self-care behaviors and sleep quality, as well as the pathways influencing sleep quality of CHF patients. Methods A convenience sampling approach was used to provide a questionnaire survey to CHF patients who were being followed up with between January and December 2021. The Pittsburgh Sleep Quality Index, Memorial Symptom Assessment Scale-Heart Failure, European Heart Failure Self- care Behavior Scale and a self-created questionnaire on sociodemographic and clinical data characteristics were all included in the survey. Results A total of 304 CHF patients were included. Among them, there were 178 males and 126 females; the average age was (61.31±14.00) years; the average sleep quality score was (8.17±4.51) points, while the average overall self-care behavior score was (21.28±3.80) points. According to the cluster analysis of the symptoms of CHF patients, the patients’ symptoms were separated into clusters related to exhaustion, disease perception, and a single symptom of dry mouth. The sleep quality score was positively correlated with the following factors: age, number of comorbidities, overall score of symptom assessment, fatigue symptom cluster score, and illness perception symptom cluster score (P<0.05). There was no significant correlation between the self-care behavior score and sleep quality (P>0.05). However, sleep quality scores were negatively correlated with body mass index and education level, respectively (P<0.05). Age, gender, score of illness perception symptom cluster, and fatigue symptom cluster all had direct effects on sleep quality of 0.014, 0.206, 0.487, and 0.165 (P<0.05), respectively, according to path analysis. Self-care behavior also had a direct influence of 0.018 (P=0.686). Conclusions CHF patients have somewhat high levels of self-care behaviors, but they have poor sleep quality. They still have a lot of symptoms after being released. Sleep quality is significantly impacted by the patients’ age, body mass index, educational attainment, number of comorbidities, symptom ratings, fatigue symptom clusters, and disease perception symptom clusters. While the route effects of the patients’ self-care actions are not statistically significant, the age, gender, disease perception, and fatigue symptom cluster scores of CHF patients have a direct impact on the quality of their sleep. By managing the same clusters of symptoms, nursing staff can help patients with CHF feel better. They can also help patients sleep better by adopting practical measures.
Objective To systematically evaluate the prognostic prediction model for chronic heart failure patients in China, and provide reference for the construction, application, and promotion of related prognostic prediction models. Methods A comprehensive search was conducted on the studies related to prognostic prediction model for Chinese patients with chronic heart failure published in The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, VIP, Wanfang, and the China Biological Medicine databases from inception to March 31, 2023. Two researchers strictly followed the inclusion and exclusion criteria to independently screen literature and extract data, and used the prediction model risk of bias assessment tool (PROBAST) to evaluate the quality of the models. Results A total of 25 studies were enrolled, including 123 prognostic prediction models for chronic heart failure patients. The area under the receiver operating characteristic curve (AUC) of the models ranged from 0.690 to 0.959. Twenty-two studies mostly used random splitting and Bootstrap for internal model validation, with an AUC range of 0.620-0.932. Seven studies conducted external validation of the model, with an AUC range of 0.720-0.874. The overall bias risk of all models was high, and the overall applicability was low. The main predictive factors included in the models were the N-terminal pro-brain natriuretic peptide, age, left ventricular ejection fraction, New York Heart Association heart function grading, and body mass index. Conclusion The quality of modeling methodology for predicting the prognosis of chronic heart failure patients in China is poor, and the predictive performance of different models varies greatly. For developed models, external validation and clinical application research should be vigorously carried out. For model development research, it is necessary to comprehensively consider various predictive factors related to disease prognosis before modeling. During modeling, large sample and prospective studies should be conducted strictly in accordance with the PROBAST standard, and the research results should be comprehensively reported using multivariate prediction model reporting guidelines to develop high-quality predictive models with strong scalability.
Objective To evaluate the diagnostic value of brain natriuretic peptide (BNP) for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure (CHF) (n=52) or without CHF (n=30) and normal control group (n=28).Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [(649.80±141.72) pg/mL vs (59.08±18.60) pg/mL and (65.20±16.32) pg/mL，respectively,Plt;0.05].There was no significant difference of BNP level between dyspnea patients without CHF and normal group (Pgt;0.05).The plasma BNP level elevated with the worsening of heart failure (NYHA Classiffication).The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction (r=－0.673，Plt;0.001).The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) is 0.91(0.88-0.98，Plt;0.001) with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL.Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.
