比索洛尔治疗慢性心力衰竭合并慢性阻塞性肺病疗效观察

<正>慢性心力衰竭(CHF)是各种心脏疾病发展的终末阶段,慢性阻塞性肺病(COPD)目前居全球死亡原因第4位。慢性心力衰竭合并COPD的发病率逐年升高趋势,并且COPD患者高于其他患者4.5倍发展为心力衰竭[1]。近年来,由于对心衰诊治的观念已从传统的血流动力学模式转移到了神经内分泌模式,β受体阻滞剂在纠正心衰中的作用日益受到重视,但在慢性心力衰竭合并COPD患者中,由于担心β受体阻     

应用比索洛尔治疗慢性心力衰竭的研究

1　资料与方法2 0 0 0年 1月～ 2 0 0 1年 12月住我院心内科慢性心力衰竭心功能Ⅱ～Ⅳ级 (NYHA分级 )的患者 80例 ,在给予常规强心、利尿、血管紧张素转换酶抑制剂等综合治疗后分为比索洛尔组和对照组。比索洛尔组 6 4例 ,年龄在 34～ 75岁 ,男性 4 9例 ,女性 15例。对照组 16例 ,年龄 4 0～ 78岁 ,男性 12例 ,女性 4例。全部患者均排除以下情况 :(1)血压 110～ 180 5 0～ 90mmHg(1mmHg =0 .133kPa) ;(2 )Ⅰ度以上房室传导阻滞 ;(3)清醒静息状态下心率 <6 0次 min ;(4)谷草转氨酶>上限 2倍 ,肌酐≥ 30 0 μmol L ;(5 )慢性肺部疾病。比…     

比索洛尔治疗慢性心力衰竭的临床研究

目的观察β受体阻滞剂比索洛尔（博苏）对慢性心力衰竭的治疗效果。方法选择慢性心力衰竭病人80例,随机分为对照组（35例）和观察组（45例）。对照组采取强心、利尿、血管紧张素转换酶抑制剂治疗。观察组在对照组治疗基础上加用博苏1.25mg/d～7.50mg/d,疗程1年。在治疗前和观察期1年时分别对心功能（NYHA）Ⅱ级～Ⅲ级病人做血流动力学变化和临床治疗效果的评价。结果对照组和观察组总有效率分别为88.57%和95.56%。两组心力衰竭病人血流动力学指标均有改善,但治疗组心率明显减慢,病人生活质量显著提高。结论比索洛尔可显著改善慢性心力衰竭病人的远期预后。     

小剂量比索洛尔联合地高辛治疗慢性阻塞性严重肺源性心力衰竭1例

<正>1病例介绍患者,男,80岁。17年前开始出现活动后气喘,服卡托普利和复方丹参片等药治疗。6年前始用塞托溴铵和沙美特罗/氟替卡松(舒利迭)治疗,气喘减轻。5年前气喘加重伴双下肢水肿住院后开始氧疗,15 h/d。4年间住院3次,最后1次住院查体:坐位吸氧,T 36.7℃,P 160次/min,BP 90/60 mmHg,R 30次/min。神志清醒,外观消瘦,急性面容,呼吸急促,口唇稍紫绀,颈静脉怒张,肝颈静脉反流征阳性。桶状胸,双肺叩诊过清音,闻及双肺湿啰音。心     

比索洛尔治疗慢性心力衰竭患者的疗效观察

目的:探讨比索洛尔治疗慢性心力衰竭患者的疗效。方法:104例慢性心力衰竭患者被随机分成两组:对照组52例,予以常规用药(强心、利尿、扩血管)+咪哒普利治疗;治疗组52例,在常规用药+咪哒普利基础上加用比索洛尔治疗,疗程12～16周,观察治疗前后心功能、左室射血分数(LVEF)、左室舒张末内径(LVEDd)、左室收缩末内径(LVESd)、心率及血压等指标的变化。结果:治疗组总有效率明显高于对照组(92.31%:73.08%,P0.05);治疗组治疗后LVESd较治疗前显著降低[(49.86±5.20)mm:(61.80±4.58)mm,P0.05],且较对照组(57.65±4.20)mm降低更显著,P0.05,两组治疗后LVEF均有明显增高(P0.05～0.01),且治疗组明显高于对照组[(48.84±4.45)%:(37.58±3.15)%,P0.05],治疗组收缩压、舒张压、心率均较治疗前明显改善(P0.05～0.01),且舒张压[(69.4±12.98)mmHg:(75.97±13.62)mmHg]、心率[(70.99±10.7)次/min:(75.73±9.4)次/min]较对照组明显降低(P均0.05)。结论:在常规用药+咪哒普利基础上加用比索洛尔治疗慢性心力衰竭患者疗效更显著。     

贝那普利联合比索洛尔治疗慢性心力衰竭的临床研究

目的 对比观察单用贝那普利和贝那普利联合比索洛尔治疗慢性心力衰竭(CHF)的疗效.方法 选取200例CHF患者随机均分为观察组和对照组各100例,给予强心、利尿剂、扩血管等常规治疗,对照组在常规治疗的基础上给予贝那普利,观察组在常规治疗的基础上给予贝那普利联合比索洛尔治疗.结果 观察组心功能改善总有效率为90.0%,优于对照组的68.0%;观察组患者心功能明显改善,LVEF明显增加,BNP浓度明显下降,两组各指标比较差异均有统计学意义(P＜0.05).结论 贝那普利联合比索洛尔治疗慢性心力衰竭的临床疗效可靠,可改善患者的症状,值得推广.     

伊伐布雷定联合比索洛尔在老年慢性射血分数降低心力衰竭合并慢性阻塞性肺疾病中的应用价值

目的 探讨伊伐布雷定(Iva)联合比索洛尔在慢性射血分数降低心力衰竭(HFrEF)合并慢性阻塞性肺疾病(COPD)中的应用价值。方法 采用随机数字表法把90例HFrEF合并COPD患者分为对照组和观察组各45例。对照组给予富马酸比索洛尔片治疗,观察组给予Iva联合比索洛尔治疗。对比两组的疗效、心脏不良事件、比索洛尔平均日剂量、心功能指标、炎性因子和圣乔治呼吸问卷(SGRQ)评分。结果 观察组疗效明显优于对照组,再住院率明显低于对照组(P<0.05)。治疗后与对照组相比,观察组左室射血分数(LVEF)和静息心率达标率明显高,6 min步行距离(6MWD)明显长,比索洛尔平均日剂量、N末端B型利钠肽前体(NT-proBNP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、超敏C-反应蛋白(hs-CRP)、呼吸症状评分、活动受限评分、疾病影响评分和SGRQ总分均明显低(P<0.05)。结论 Iva联合比索洛尔治疗慢性HFrEF合并COPD可提高疗效、心功能和生活质量,同时可降低再住院率和炎症反应程度。     

β受体阻滞剂治疗慢性心力衰竭合并慢性阻塞性肺病

心力衰竭合并慢性阻塞性肺病发病率及致死率随着年龄增长而升高。尽管β受体阻滞剂治疗心力衰竭明确的有效性,但临床医生由于担心其引起的气道高反应性和气道痉挛而避免在心力衰竭合并慢性阻塞性肺病患者中应用该类药物。然而,越来越多的证据表明,心脏选择性β受体阻滞剂在慢性心力衰竭合并慢性阻塞性肺病患者中没有明显的不良反应,且安全性得到证实,没有证据显示其降低肺通气功能,如1秒末呼气量。     

比索洛尔治疗老年人慢性心力衰竭临床分析

慢性心力衰竭(CHF)已由改善血流动力学的药物治疗(正性肌力药物)转为拮抗过度激活的神经内分泌系统，主要是肾素-血管紧张素和交感神经系统。我们应用新型选择性β-肾上腺素受体阻滞剂比索洛尔(商品名：博苏，北京四环制药厂)治疗老年人CHF，现将临床疗效报道如下。     

Effects of trimetazidine in combination with bisoprolol in patients with chronic heart failure and concomitant chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis

Background:To the best of our knowledge, there is no study that has conducted a review investigating the clinical efficacy and safety of bisoprolol combined with trimetazidine on chronic heart failure (CHF) patients with chronic obstructive pulmonary disease (COPD). Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the effectiveness and safety of bisoprolol combined with trimetazidine on CHF patients with COPD.Methods:Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library will be searched in April 2021 by 2 independent reviewers. For search on PubMed, the following search terms will be used: “trimetazidine, bisoprolol, chronic heart failure, chronic obstructive pulmonary disease.” In order to achieve a consistency of extracted items, the data extractors will extract data from a sample of eligible studies. The outcomes include all-cause mortality and hospitalization for cardiac or/and respiratory causes; left ventricular structure and function; and functional scores. Review Manager software (v 5.4; Cochrane Collaboration) will be used for the meta-analysis. Two independent reviewers will assess the risk of bias of the included studies at study level. Any disagreements will be discussed and resolved in discussion with a third reviewer.Results:The results of our review will be reported strictly following the PRISMA criteria.Conclusions:The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.OSF registration number:10.17605/OSF.IO/ZWPRB.     

富马酸比索洛尔治疗心力衰竭患者的临床观察

目的　观察国产β受体阻滞剂———富马酸比索洛尔治疗充血性心力衰竭 (心衰 )患者的最大耐受剂量及对心功能的影响。方法　符合本试验纳入标准的 30例心衰患者 ,在口服地高辛、血管紧张素转换酶抑制剂、血管扩张剂 (非钙离子拮抗剂 )和利尿剂等基本抗心衰药物的基础上 ,加服比索洛尔。观察国人对此药的耐受性 ,同时测定患者试验初始时和服药 7个月后左室射血分数 (LVEF)等指标。结果　国内心衰患者服用国产富马酸比索洛尔的每次和每日最大耐受剂量不同 ,但两者主要分布在 5mg。随访 7个月 ,B超复查LVEF平均值为 (4 2± 3.2 ) % ,与试验初比较有极显著的改善 (P <0 .0 1)。结论　在基本心衰治疗用药的基础上加用比索洛尔治疗 ,应按照个体化用药原则 ,患者对此药的耐受程度主要分布在 5mg。经富马酸比索洛尔治疗 7个月的心衰患者心功能改善更显著     

The prognostic influence of chronic obstructive pulmonary disease in patients hospitalised for chronic heart failure

AIMS: To investigate the prevalence and the prognostic impact of chronic obstructive pulmonary disease (COPD), in patients hospitalised with chronic heart failure (CHF). METHODS AND RESULTS: In an observational study based on longitudinal information from administrative registers, 1020 patients aged >or=60 years, who were chronically treated for and hospitalised with CHF were identified and followed-up for major events up to 1 year. Median age was 80 years, half of the patients were female and 241 patients (23.6%) had concomitant COPD. There were no differences in the prevalence of cardiovascular and non-cardiovascular comorbidities between CHF patients with or without COPD. However, COPD patients were more often male (60.6% vs. 46.3%), more frequently treated with diuretics (95.9% vs. 91.5%) but less often exposed to beta-blockers (16.2% vs. 22.0%). Significantly higher adjusted in-hospital (HR 1.50 [95%CI 1.00-2.26]) and out-of-hospital (1.42 [1.09-1.86]) mortality rates were found in CHF patients with concomitant COPD. A higher occurrence of non-fatal AMI/stroke/rehospitalisation for CHF (1.26 [1.01-1.58]) as well as hospitalisation for CHF (1.35 [1.00-1.82]) was associated with COPD. CONCLUSIONS: COPD is a frequent concomitant disease in patients with heart failure and it is an independent short-term prognostic indicator of mortality and cardiovascular comorbidity in patients who have been admitted to hospital for heart failure.     

56例慢性肺源性心脏病临床分析

目的　探讨慢性肺源性心脏病的临床特点及防治措施。方法　对 2 0 0 2年 10月至 2 0 0 4年 1月 5 6例慢性肺心病的临床表现、实验室及辅助检查和治疗措施进行回顾性析。结果　慢性肺源性心脏病的病因以慢性阻塞性肺疾病最常见 ,多有长期大量吸烟史 ;临床表现有发热、咳嗽、咳白粘痰、呼吸困难、肺部罗音、紫绀和浮肿 ,常合并有电解质紊乱、肝肾功能损害 ;死因主要为心力衰竭和呼吸衰竭。结论　慢性肺源性心脏病病情复杂 ,常合并有多脏器功能改变 ,临床治疗应采取以抗感染、合理氧疗、加强营养和对症治疗为主的综合措施 ,机械通气治疗日益受到重视。戒烟和预防上呼吸道感染是减少发病率和阻止病情发展的重要措施。     

慢性肺源性心脏病76例临床分析

目的探讨慢性肺源性心脏病的临床特点及防治措施。方法对76例慢性肺源性心脏病进行临床资料分析。结果慢性肺源性心脏病的病因以慢性阻塞性肺疾病最常见,多有长期大量吸烟史;临床表现以发热、咳嗽、咳白粘痰、呼吸困难、肺部啰音、紫绀和浮肿为主,咳痰以白粘痰为主;常合并有电解质紊乱、肝肾功能损害;死因主要为心力衰竭和呼吸衰竭。结论慢性肺源性心脏病病情复杂,常合并有多脏器功能改变。临床治疗应采取以抗感染、合理氧疗、加强营养和对症治疗为主的综合措施及机械通气治疗。     

Readmission patterns in patients with chronic obstructive pulmonary disease, chronic heart failure and diabetes mellitus: an administrative dataset analysis

Comprehensive disease management programmes for chronic disease aim to improve patient outcomes and reduce health-care utilization. Readmission rates are often used as an outcome measure of effectiveness. This study aimed to document readmission rates, and risk for early and late readmission, for patients discharged from the Royal Melbourne Hospital with a disease diagnosis of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus compared to those with other general medical conditions. Eighty five (8.6%) of patients were readmitted within 28 days and 183 (20.8%) were readmitted between 29 and 180 days. No risk factors for early readmission were identified. Patients with a primary disease diagnosis of CHF and COPD are at increased risk of late readmissions (29-180 days).     

Acute care costs of patients admitted for management of chronic obstructive pulmonary disease exacerbations: contribution of disease severity,infection and chronic heart failure

Background: In 2003, chronic obstructive pulmonary disease (COPD) accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65–74‐year‐old age group, COPD was the sixth leading cause of disability for men and the seventh for women. Aims: To measure the influence of disease severity, COPD phenotype and comorbidities on acute health service utilization and direct acute care costs in patients admitted with COPD. Methods: Prospective cohort study of 80 patients admitted to the Royal Melbourne Hospital in 2001–2002 for an exacerbation of COPD. Patients were followed for 12 months and data were collected on acute care utilization. Direct hospital costs were derived using Transition II, an activity‐based costing system. Individual patient costs were then modelled to ascertain which patient factors influenced total direct hospital costs. Results: Direct costs were calculated for 225 episodes of care, the median cost per admission was AU$3124 (interquartile range $1393 to $5045). The median direct cost of acute care management per patient per year was AU$7273 (interquartile range $3957 to $14 448). In a multivariate analysis using linear regression modelling, factors predictive of higher annual costs were increasing age (P= 0.041), use of domiciliary oxygen (P= 0.008) and the presence of chronic heart failure (P= 0.006). Conclusion: This model has identified a number of patient factors that predict higher acute care costs and awareness of these can be used for service planning to meet the needs of patients admitted with COPD.     

小剂量托拉塞米持续泵注辅助NIV治疗COPD合并心功能不全水肿疗效观察

目的:探讨小剂量托拉塞米持续泵注辅助NIV治疗COPD合并心功能不全临床效果。方法：研究对象选取我院2010年1月-2015年5月收治COPD合并重度水肿患者共130例,采用随机区组法分为对照组（65例）和观察组（65例）,分别在常规对症干预基础上给予NIV单用和与小剂量托拉塞米持续泵注联用治疗,比较两组患者临床疗效,治疗前后血清离子指标、呼吸频率、心率、血气分析指标及24h尿量水平等。结果：两组患者治疗前后血清离子指标水平比较差异无显著性（p<0.05）;观察组患者治疗后呼吸频率和心率水平均明显优于对照组、治疗前,差异具有显著性（p<0.05）;观察组患者治疗后血气分析指标水平均明显优于对照组、治疗前,差异具有显著性（p<0.05）;观察组患者治疗后24h尿量水平明显多于对照组、治疗前,差异具有显著性（p<0.05）。结论：小剂量托拉塞米持续泵注辅助NIV治疗COPD合并心功能不全可有效缓解水肿症状体征,观察组患者临床疗效明显优于对照组;改善心肺功能,并有助于增加24h尿量。     

Heart failure and chronic obstructive pulmonary disease the quandary of Beta-blockers and Beta-agonists

The combination of heart failure and chronic obstructive pulmonary disease presents many therapeutic challenges. The cornerstones of therapy are beta-blockers and beta-agonists, respectively. Their pharmacological effects are diametrically opposed, and each is purported to adversely affect the alternative condition. The tolerability of beta-blockade in patients with mild and fixed airflow obstruction likely extends to those with more severe disease. However, the evidence is rudimentary. The long-term influence of beta-blockade on pulmonary function, symptoms, and quality of life is unclear. Low-dose initiation and gradual up-titration of cardioselective beta-blockers is currently recommended. Robust clinical trials are needed to provide the answers that may finally allay physicians' mistrust of beta-blockers in patients with chronic obstructive pulmonary disease. Beta-agonists are associated with incident heart failure in patients with pulmonary disease and with increased mortality and hospitalization in those with existing heart failure. These purported adverse effects require further investigation. In the meantime, clinicians should consider carefully the etiology of dyspnea and obtain objective evidence of airflow obstruction before prescribing beta-agonists to patients with heart failure.