{"title":"精氨酸-肉碱复合治疗和标准方案治疗对心肌梗死合并下肢严重缺血患者生活质量的影响","authors":"M. Shved, T. Dobryansky, I. Yastremska","doi":"10.25040/lkv2022.01-02.008","DOIUrl":null,"url":null,"abstract":"Introduction. The presence of critical lower extremity ischemia (CLEI) in patients with acute coronary syndrome (ACS) limits the possibility of early invasive interventions and determines the tactics of medical preparation for surgery and prevention of complications. The aim of the study. To assess the dynamics of life quality using the EQ-5D-5L questionnaire in patients with myocardial infarction (MI) in combination with obliterative atherosclerosis of the main vessels at the stage of critical lower extremity ischemia and high risk of cardiac complications in the inpatient phase of treatment under the influence of metabolic therapy. Materials and methods. 67 patients with ACS (MI) in combination with CLEI due to stenotic atherosclerosis of the iliac-femoral arterial segment were examined: 35 patients of the main group who underwent emergency balloon angioplasty and infarct-dependent coronary artery stenting in addition with L-arginine/L-carnitine complex (“TIVOR-L”; “Yuri-Pharm”; in the form of intravenous infusions for seven days of 100.0 ml once / day). 32 patients in the comparison group received only standard protocol treatment. All patients, in addition to general clinical, laboratory and instrumental methods, were additionally assessed for quality of life according to the EQ-5D-5L questionnaire. Statistical processing of indicators was performed by the method of variation statistics. Samples were checked for normality of data distribution according to the test of S. Shapiro – M. Wilk, parametric (t-test, Student’s test) methods were used. Confidence interval (CI) and relative risk (RR) were used to more accurately assess the accuracy. Results. In patients of both groups, the severity of the clinical condition did not differ significantly and was due to typical manifestations of ACS and CLEI. In patients of the main group, the use of intravenous infusions of arginine-carnitine mixture against the background of the standard protocol treatment program led to the elimination of anginal syndrome in all patients and reduced functional class of acute heart failure. When evaluating the effectiveness of the proposed combination treatment and its subjective perception by patients, it was found that initially patients of both groups evaluated their quality of life with similar relatively low scores: an average of 26.14 ± 10.15 and 25.68 ± 9.74 points (p-value more than 0.05). We note a significantly higher assessment of quality of life in patients after a course of comprehensive treatment, whose quality of life index improved by an average of 160.9 % and reached the level of 86.5 ± 8.3 points. During the standard treatment program in patients with ACS in combination with CLEI there was a significant improvement in well-being, the total quality of life index increased by 40.2 %. Сonclusions. Patients in the experimental group with acute coronary syndrome and critical lower extremity ischemia who received arginine-carnitine mixture in addition to complex standard protocol drug treatment had significantly reduced feelings of chest pain/discomfort and anxiety / depression and tended to increase motor activity.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"22 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dynamics of Life Quality in Patients with Myocardial Infarction in Combination with Critical Ischemia of the Lower Extremities under the Influence of Complex Treatment Using Arginine-carnitine Mixture and Standard Protocol Treatment\",\"authors\":\"M. Shved, T. Dobryansky, I. Yastremska\",\"doi\":\"10.25040/lkv2022.01-02.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction. The presence of critical lower extremity ischemia (CLEI) in patients with acute coronary syndrome (ACS) limits the possibility of early invasive interventions and determines the tactics of medical preparation for surgery and prevention of complications. The aim of the study. To assess the dynamics of life quality using the EQ-5D-5L questionnaire in patients with myocardial infarction (MI) in combination with obliterative atherosclerosis of the main vessels at the stage of critical lower extremity ischemia and high risk of cardiac complications in the inpatient phase of treatment under the influence of metabolic therapy. Materials and methods. 67 patients with ACS (MI) in combination with CLEI due to stenotic atherosclerosis of the iliac-femoral arterial segment were examined: 35 patients of the main group who underwent emergency balloon angioplasty and infarct-dependent coronary artery stenting in addition with L-arginine/L-carnitine complex (“TIVOR-L”; “Yuri-Pharm”; in the form of intravenous infusions for seven days of 100.0 ml once / day). 32 patients in the comparison group received only standard protocol treatment. All patients, in addition to general clinical, laboratory and instrumental methods, were additionally assessed for quality of life according to the EQ-5D-5L questionnaire. Statistical processing of indicators was performed by the method of variation statistics. Samples were checked for normality of data distribution according to the test of S. Shapiro – M. Wilk, parametric (t-test, Student’s test) methods were used. Confidence interval (CI) and relative risk (RR) were used to more accurately assess the accuracy. Results. In patients of both groups, the severity of the clinical condition did not differ significantly and was due to typical manifestations of ACS and CLEI. In patients of the main group, the use of intravenous infusions of arginine-carnitine mixture against the background of the standard protocol treatment program led to the elimination of anginal syndrome in all patients and reduced functional class of acute heart failure. When evaluating the effectiveness of the proposed combination treatment and its subjective perception by patients, it was found that initially patients of both groups evaluated their quality of life with similar relatively low scores: an average of 26.14 ± 10.15 and 25.68 ± 9.74 points (p-value more than 0.05). We note a significantly higher assessment of quality of life in patients after a course of comprehensive treatment, whose quality of life index improved by an average of 160.9 % and reached the level of 86.5 ± 8.3 points. During the standard treatment program in patients with ACS in combination with CLEI there was a significant improvement in well-being, the total quality of life index increased by 40.2 %. Сonclusions. Patients in the experimental group with acute coronary syndrome and critical lower extremity ischemia who received arginine-carnitine mixture in addition to complex standard protocol drug treatment had significantly reduced feelings of chest pain/discomfort and anxiety / depression and tended to increase motor activity.\",\"PeriodicalId\":279640,\"journal\":{\"name\":\"Lviv clinical bulletin\",\"volume\":\"22 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lviv clinical bulletin\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.25040/lkv2022.01-02.008\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lviv clinical bulletin","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25040/lkv2022.01-02.008","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
介绍。急性冠脉综合征(ACS)患者存在严重下肢缺血(CLEI),限制了早期介入治疗的可能性,并决定了手术前的医疗准备策略和并发症的预防。研究的目的。采用EQ-5D-5L问卷评价代谢治疗对急性下肢缺血期伴有主干血管闭塞性动脉粥样硬化、住院期心脏并发症高危期心肌梗死患者生活质量的影响。材料和方法。对67例因髂-股动脉段狭窄性动脉粥样硬化导致的ACS (MI)合并CLEI患者进行了检查:主组35例患者接受了紧急球囊血管成形术和梗死依赖性冠状动脉支架置入术,并使用了l -精氨酸/ l -肉碱复合物(“TIVOR-L”);“Yuri-Pharm”;以100.0 ml /天1次静脉滴注7天的形式。对照组32例患者仅接受标准方案治疗。除一般临床、实验室和仪器方法外,根据EQ-5D-5L问卷对所有患者的生活质量进行额外评估。采用变异统计法对指标进行统计处理。根据S. Shapiro - M. Wilk检验检验样本数据分布的正态性,采用参数(t检验,学生检验)方法。采用置信区间(CI)和相对风险(RR)来更准确地评估准确性。结果。两组患者临床病情严重程度无明显差异,均为ACS和CLEI的典型表现。在主组患者中,在标准方案治疗方案的背景下静脉输注精氨酸-肉碱混合物,所有患者心绞痛综合征消除,急性心力衰竭功能分级降低。在评价联合治疗的有效性和患者的主观感受时,发现两组患者对生活质量的初始评价得分相似,均较低,平均为26.14±10.15分和25.68±9.74分(p值大于0.05)。我们注意到综合治疗后患者的生活质量评价明显提高,其生活质量指数平均提高160.9%,达到86.5±8.3分水平。在ACS合并CLEI患者的标准治疗方案中,幸福感显著改善,总生活质量指数提高了40.2%。Сonclusions。实验组急性冠状动脉综合征和严重下肢缺血患者在接受复杂标准方案药物治疗的基础上,接受精氨酸-肉碱混合物治疗,胸痛/不适感和焦虑/抑郁感明显减轻,运动活动倾向增加。
Dynamics of Life Quality in Patients with Myocardial Infarction in Combination with Critical Ischemia of the Lower Extremities under the Influence of Complex Treatment Using Arginine-carnitine Mixture and Standard Protocol Treatment
Introduction. The presence of critical lower extremity ischemia (CLEI) in patients with acute coronary syndrome (ACS) limits the possibility of early invasive interventions and determines the tactics of medical preparation for surgery and prevention of complications. The aim of the study. To assess the dynamics of life quality using the EQ-5D-5L questionnaire in patients with myocardial infarction (MI) in combination with obliterative atherosclerosis of the main vessels at the stage of critical lower extremity ischemia and high risk of cardiac complications in the inpatient phase of treatment under the influence of metabolic therapy. Materials and methods. 67 patients with ACS (MI) in combination with CLEI due to stenotic atherosclerosis of the iliac-femoral arterial segment were examined: 35 patients of the main group who underwent emergency balloon angioplasty and infarct-dependent coronary artery stenting in addition with L-arginine/L-carnitine complex (“TIVOR-L”; “Yuri-Pharm”; in the form of intravenous infusions for seven days of 100.0 ml once / day). 32 patients in the comparison group received only standard protocol treatment. All patients, in addition to general clinical, laboratory and instrumental methods, were additionally assessed for quality of life according to the EQ-5D-5L questionnaire. Statistical processing of indicators was performed by the method of variation statistics. Samples were checked for normality of data distribution according to the test of S. Shapiro – M. Wilk, parametric (t-test, Student’s test) methods were used. Confidence interval (CI) and relative risk (RR) were used to more accurately assess the accuracy. Results. In patients of both groups, the severity of the clinical condition did not differ significantly and was due to typical manifestations of ACS and CLEI. In patients of the main group, the use of intravenous infusions of arginine-carnitine mixture against the background of the standard protocol treatment program led to the elimination of anginal syndrome in all patients and reduced functional class of acute heart failure. When evaluating the effectiveness of the proposed combination treatment and its subjective perception by patients, it was found that initially patients of both groups evaluated their quality of life with similar relatively low scores: an average of 26.14 ± 10.15 and 25.68 ± 9.74 points (p-value more than 0.05). We note a significantly higher assessment of quality of life in patients after a course of comprehensive treatment, whose quality of life index improved by an average of 160.9 % and reached the level of 86.5 ± 8.3 points. During the standard treatment program in patients with ACS in combination with CLEI there was a significant improvement in well-being, the total quality of life index increased by 40.2 %. Сonclusions. Patients in the experimental group with acute coronary syndrome and critical lower extremity ischemia who received arginine-carnitine mixture in addition to complex standard protocol drug treatment had significantly reduced feelings of chest pain/discomfort and anxiety / depression and tended to increase motor activity.