卡维地洛在充血性心力衰竭治疗中的应用

目的研究新型β-受体阻滞剂国产卡维地洛(Carvedilol)对充血性心力衰竭患者心功能及神经内分泌激素的影响。方法40例住院慢性充血性心力衰竭患者,双盲随机分为安慰剂组及治疗组。治疗组在常规治疗基础上加服卡维地洛,安慰剂组在常规治疗基础上加服用等量安慰剂片。观察心率、血压、6 min步行距离、心功能级别、超声心动图测量左室射血分数(LVEF)、左室内径(LVDd),血浆去甲肾上腺素(NE)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)及血生化指标,并分别于治疗后1个月,3个月复查。结果心力衰竭患者血浆中NE、PRA、AngⅡ水平均较正常安慰剂组明显升高(P<0.01),且心衰越重,升高越明显。治疗组经治疗后血浆NE、PRA、AngⅡ水平均较治疗前明显下降(P<0.01),且心衰恶化发生率亦明显低于安慰剂组,严重心脏事件发生率亦较安慰剂组降低了76%(P=0.028),6 min步行距离、心功能级别均有明显改善,LVEF明显提高,LVDd缩小。结论卡维地洛能降低心衰患者血循环去甲肾上腺素、肾素及血管紧张素水平,改善慢性充血性心力衰竭患者的生活质量,改善心功能。

The effects of carvedilol on heart function and neurohormones in patients with congestive heart failure

Objective To investigate the effects of Carvedilol on heart function and neorohormones in patients with congestive heart failure(CHF) by double-blind randomized clinical trial.Method40 congestive heart failure patients were double-blind randomly divided into two groups,20 of them randomized to Carvedidilol with routine therapy group and 20 patients to Placebo with routine therapy group.The change of heart rate,blood pressure,NYHA classification,6 min.walk distance,left ventricular ejection fraction(LVEF) and left ventricular diastolic dimension(LVDd) by 2-D Echocardiography were observed before and 1、3 months after treatment,meanwhile the plasma concentration of norepinephrine,renin and angiotensin II in patients who were supine position were measured in the morning before and 6 weeks after treatment.ResultsThe study showed the patients' heart rate,blood pressure,NYHA classification,6 min.walk distance,LVEDd,LVEF significantly improved.The plasma concetration of norepinephrine,renin,angiotensin II in patients with CHF were higher than those of healthy control group(P<0.01),and signicantly reduced(P<0.01) after treatment with Carvedilol compared with routine treatment.No patient died and had heart failure worsened in carvedilol group,but 6 patients were rehospitalized because of worsening heart failure in Placebo group.ConclusionIt was indicated that Carvedilol could signicantly improve heart function and reduce the plasma concentration of neurohormones in patients with congestive heart failure.