本文關(guān)鍵詞：前列地爾治療老年高血壓所致良性小動脈性腎硬化癥臨床療效觀察　出處：《河北醫(yī)科大學》2015年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 前列地爾 良性小動脈性腎硬化 高血壓 老年 尿蛋白 尿微量白蛋白 腎功能

【摘要】：目的:研究前列地爾注射液在治療老年高血壓引起的良性小動脈性腎硬化癥的臨床療效;觀察前列地爾注射液對腎臟的保護作用;觀察前列地爾注射液治療良性小動脈性腎硬化癥的安全性。方法:選擇2013年11月到2014年11月在承德市中心醫(yī)院老年病科住院的老年原發(fā)性高血壓所致良性小動脈性腎硬化癥患者,入選病例共100例,隨機分為試驗組與對照組。入選患者均符合以下三項診斷標準:一、良性小動脈性腎硬化癥的診斷標準,即:①符合原發(fā)性高血壓診斷標準。②高血壓病程一般大于10年。③尿常規(guī)提示有輕至中度蛋白尿,尿鏡檢有形成份少。④常伴隨視網(wǎng)膜動脈硬化改變。⑤排除原發(fā)、繼發(fā)性腎臟疾病。二、入選患者均符合2010年由中國高血壓聯(lián)盟和國家心血管病中心頒布的《中國高血壓防治指南2010》為依據(jù)的高血壓診斷標準。三、入選患者均符合我國老年人的診斷標準,即大于60歲。入選前需排除繼發(fā)性高血壓患者;原發(fā)、繼發(fā)腎臟疾病患者;嚴重心功能不全患者;青光眼及高眼壓患者;既往有胃潰瘍及消化道出血患者;間質(zhì)性肺炎患者;糖尿病腎病患者;對前列地爾制劑有過敏史患者;有其他危及生命的嚴重疾病(如惡性腫瘤等)患者。剔除中途要求停止用藥以及未按照試驗設(shè)計方法用藥者;剔除因感染或其他因素,在治療過程導致腎功能損害者。所有入選病人均給予常規(guī)的控制血壓治療,首先給予生活方式干預(yù):控制體重,合理運動,戒煙限酒,調(diào)整心態(tài),保持樂觀情緒;選擇降壓藥物時需首選ACEI類藥物如依那普利,如果因不良反應(yīng)等不能耐受則選擇ARB類藥物如厄貝沙坦,根據(jù)血壓水平必要時輔以鈣離子拮抗劑如氨氯地平或β受體阻滯劑如比索洛爾治療,盡量避免使用利尿劑,以免干擾觀察指標。試驗組在常規(guī)治療方法上給予靜脈泵入0.9%氯化鈉注射液50毫升+前列地爾注射液10微克,每日一次治療,治療14天后判斷前列地兒對良性小動脈性腎硬化癥的治療效果及安全性。結(jié)果:兩組患者在性別比例、年齡分布、既往吸煙飲酒史、用藥前血壓水平、用藥前腎功能水平(包括血尿素氮、血肌酐、血尿酸)、24小時尿蛋白定量、尿微量白蛋白排泄率等指標方面均無顯著的統(tǒng)計學差異,具有可比性(P0.05)。兩組入選患者經(jīng)過14天的治療后,試驗組的總有效率達到96.00%,明顯高于對照組的有效率52%(P0.05);兩組患者的腎功能情況包括血尿素氮、血肌酐、血尿酸水平及患者的24小時尿蛋白定量、尿微量白蛋白排泄率均有下降,而試驗組治療后的上述指標明顯低于對照組(P0.05),具有統(tǒng)計學意義;治療前后兩組患者血壓水平無統(tǒng)計學差異,治療后兩組患者血壓均達標,均在130/80mm Hg以下;同時試驗組及對照組治療過程中均未發(fā)現(xiàn)患者不能耐受的明顯不良反應(yīng),實驗組有兩例患者用藥過程中出現(xiàn)輸液局部皮膚發(fā)紅、疼痛,但患者可以耐受,治療過程不受影響。治療后檢測肝功能、血常規(guī)等未發(fā)現(xiàn)與應(yīng)用藥物損傷相關(guān)的異常變化。結(jié)論:前列地爾注射液可以用于治療老年高血壓所致良性小動脈性腎硬化癥,并能改善患者腎臟的損害情況,起到保護腎功能作用,療效顯著,副作用小,值得推廣。
[Abstract]:Objective: To study the clinical curative effect caused by Alprostadil Injection in the treatment of hypertension in the elderly benign arteriolar nephrosclerosis; observe the Alprostadil Injection protective effect on the kidney; to evaluate the safety of Alprostadil Injection for the treatment of benign arteriolar nephrosclerosis. Methods: from November 2013 to November 2014 in the Department of geriatrics in elderly hospitalized in Chengde Central Hospital in patients with primary hypertension caused by benign arteriolar nephrosclerosis, a total of 100 selected patients were randomly divided into experimental group and control group. All patients met the following criteria: three, diagnostic criteria, benign arteriolar nephrosclerosis is: consistent with the diagnosis of primary hypertension. The general hypertension duration greater than 10 years. The urine routine suggestive of mild to moderate proteinuria, microscopic examination of urine visible components. The less often associated with retinal arteriosclerosis. The change in primary, Secondary kidney disease. Two patients conformed to 2010 promulgated by the China hypertension alliance and the National Center for cardiovascular disease: guidelines for prevention and treatment of hypertension 2010> Chinese hypertension diagnostic criteria. Three patients were accorded with the diagnostic standard of the elderly in China, which is more than 60 years old. Selected before secondary hypertension were excluded; primary and secondary kidney disease; severe heart failure patients and patients with high intraocular pressure; glaucoma; patients with a gastric ulcer and gastrointestinal bleeding; interstitial pneumonia; diabetic nephropathy; patients with a history of allergy to alprostadil preparation; other life-threatening serious diseases (such as cancer and patients) excluding the half-way stop medication. And not in accordance with the experimental design method of the drug; removed due to infection or other factors that lead to the loss of renal function in the course of treatment. All the patients were given often Control blood pressure gauge, given lifestyle intervention first: weight control, reasonable exercise, quit alcohol limit, attitude adjustment, optimistic mood; be preferred ACEI drugs such as enalapril choose antihypertensive drugs, if because of adverse reaction of intolerance to select ARB drugs such as irbesartan, according to blood pressure levels when necessary with calcium ion antagonists such as amlodipine or beta blockers such as bisoprolol treatment, to avoid the use of diuretics, so as not to interfere with the observation index. The experimental group was given intravenous infusion of 50 ml of 0.9% Sodium Chloride Injection + Alprostadil Injection 10 micrograms in the conventional treatment methods, treatment once a day, 14 days after treatment of Alprostadil in benign arteriolar nephrosclerosis treatment the effect and safety of judgment. Results: the age distribution of patients in the two groups in sex ratio, smoking history, drinking history, blood pressure level before treatment, before treatment of kidney Function level (including blood urea nitrogen, serum creatinine, blood uric acid), 24 hour urinary protein, showed no significant statistical difference of urinary albumin excretion rate and other indicators, comparable (P0.05). Two groups of patients after 14 days of treatment, the experimental group's total effective rate reached 96%. The effective rate was significantly higher than the control group 52% (P0.05); renal function in the patients of the two groups including blood urea nitrogen, serum creatinine, blood uric acid level of patients and 24 hour urinary protein, urinary albumin excretion rate decreased, and the index of experimental group after treatment was significantly lower than the control group (P0.05), with statistical significance; no statistical difference between the two groups in the level of blood pressure before and after treatment, after treatment, the blood pressure of the two groups are standard, all in the 130/80mm below Hg; at the same time, the experimental group and the control group in the course of treatment without obvious adverse reaction in patients intolerant of the experiment Group infusion of local skin redness, appeared in two patients during the treatment of pain, but patients can be tolerated, the treatment process is not affected. The detection of liver function after treatment, blood routine changes were found associated with the application of drug injury. Conclusion: Alprostadil Injection can be used in the treatment of senile hypertension caused by benign arteriolar nephrosclerosis, and patients can improve the kidney damage, to protect renal function, obvious curative effect, little side effect, it is worthy of promotion.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R544.1;R692

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