卡维地洛联合曲美他嗪对缺血性心肌病心衰患者左室功能及QT间期离散度的影响

目的探讨卡维地洛联合曲美他嗪对缺血性心肌病心衰患者左室功能及QT间期离散度的影响。方法将我院诊治的80例缺血性心肌病心衰患者随机分入对照组与治疗组,对照组患者接受卡维地洛口服,治疗组患者接受卡维地洛联合曲美他嗪口服,疗程6个月。比较两组左室功能、血压、心率及QT间期离散度的改变。结果治疗6个月后,治疗组左室舒张末期内径(LVEDd)、左室射血分数(LVEF)、室间隔厚度(IVSD)、左室重量指数(LVMI)及左室后壁(PWTD)显著优于对照组(P<0.05);与对照组相比,治疗组QT间期离散度(QTd)及心率校正QT间期(QTcd)显著下降(P<0.05);两组治疗后心率、收缩压(SBP)及舒张压(DBP)差异无统计学意义(P>0.05)。结论卡维地洛联合曲美他嗪治疗缺血性心肌病心衰可显著改善患者左室功能,缩短QTd及QTcd。     

Left ventricular diastolic function improvement by carvedilol therapy in advanced heart failure

Carvedilol treatment in chronic heart failure (CHF) patients has been demonstrated to reduce mortality by improving cardiac systolic function and reducing left ventricular adverse remodeling. However, the effects of the drug on left ventricular (LV) filling are less studied. In this study we evaluated early and long-term diastolic cardiac modifications by an echo-Doppler method during carvedilol therapy in patients with advanced CHF and pseudonormal or restrictive filling pattern. We studied 58 patients with severe but stable CHF (39 in class NYHA III and 19 in IV) having systolic and diastolic dysfunction caused by idiopathic or ischemic cardiomyopathy. Thirty-two patients were randomized to receive previous treatment plus carvedilol (group 1) and 26 continued standard therapy (group 2). In all subjects we evaluated LV volumes, LV mass, LV ejection fraction (EF), and the following transmitral filling parameters: early wave (E), atrial wave (A), E/A ratio, deceleration time (DT), and isovolumetric releasing time (IVRT). After 4 months of therapy, the carvedilol group showed a significant increase of A wave (P < 0.001), DT (P < 0.0001), IVRT (P < 0.0001), and a significant reduction of E/A ratio (P < 0.0005) with respect to group 2. Further improvement was observed at 12 months (A P < 0.0005; DT P < 0.00002; IVRT P < 0.000004; E/A P < 0.0008), although an E wave reduction was observed in group 1 with respect to controls (P < 0.001). Moreover, after 1 year of follow-up a reduction of systolic volume (P < 0.001) and pulmonary pressure (P < 0.0001) and consequent increase of EF (P < 0.001) was observed in the carvedilol group. Carvedilol treatment improved diastolic function in CHF with severe diastolic and systolic impairment at early time, converting a restrictive or pseudonormal filling pattern into an altered pattern. These changes remained significant after 1 year of therapy together with improvement in systolic function.     

卡维地洛对慢性心衰合并肾功能不全患者肾功能的影响

目的:评价卡维地洛对慢性心衰(CHF)合并慢性肾功能不全(CRF)患者肾功能的影响。方法:入选27例CHF合并CRF患者,在充分抗心力衰竭治疗的基础上,加用卡维地洛,观察不同阶段左室射血分数(LVEF)和肾功能的变化。结果:卡维地洛治疗后,LVEF在治疗3个月后开始升高,12个月后显著高于基线水平(p<0.01)。治疗后1个月,血肌酐(Scr)升高(p<0.05),3个月时回落到基线水平以下(p<0.05),12个月时仍低于基线水平(p<0.05);治疗后1个月,内生肌酐清除率(Ccr)先轻度下降(p<0.05),3个月时回升高于基线水平(p<0.01),12个月时仍显著高于基线水平(p<0.01)。卡维地洛对尿微量白蛋白和24h尿蛋白定量影响不大(p>0.05)。结论:第三代β-受体阻滞剂卡维地洛,可改善慢性心衰合并慢性肾功能不全患者的心功能,早期引起肾功能的轻度降低,随后肾功能显著改善。     

卡维地洛对老年收缩期高血压并心力衰竭的治疗观察

目的：探讨卡维地洛对老年收缩期高血压合并心力衰竭患者的临床治疗效果。方法：将本科老年收缩期高血压合并心力衰竭患者100例随机分为对照组和观察组,两组患者均给予基础用药,观察组加用卡维地洛,于治疗3周及24周后比较两组患者的血压、心率、心功能等临床指标。结果：观察组患者治疗3周后相对于对照组血压、心率改善明显（P〈0.05）,心功能两组间无明显差异（P〉0.05）;在治疗24周后,观察组心功能改善明显（P〈0.05）。结论：卡维地洛短期使用即可改善血压、心率,长期使用能够进一步改善心功能。     

卡维地洛治疗慢性心力衰竭的疗效观察

目的：观察卡维地洛治疗慢性心力衰竭的疗效。方法：64例慢性心力衰竭患者随机分为2组，常规治疗组予以利尿剂、血管紧张素转换酶抑制剂和洋地黄等治疗，卡维地洛组在此基础上加用卡维地洛，治疗6个月后对比观察2组临床症状、心率、血压、心功能级别和左室射血分数变化情况。结果：卡维地洛组各项指标均明显改善，患者生活质量明显提高。结论：卡维地洛可作为治疗慢性心力衰竭的有效药物应用于临床。     

Dissociation between improvement in left ventricular performance and functional class in patients with chronic heart failure

Resting left ventricular ejection fraction (LVEF) and functional capacity do not correlate in chronic heart failure patients treated with digitalis, diuretics, and angiotensin-converting enzyme inhibitors. We sought to determine whether substantial improvement in LVEF, as may occur during long-term beta-blockade or after coronary artery bypass graft (CABG) surgery, leads consistently to improvement in functional class. Doppler echocardiogram and assessment of functional class were obtained at baseline and 12 months after initiation of beta-blockade (87 patients) or CABG surgery (51 patients). At 12 months the effects of beta-blockade were variable: LVEF increased greatly by >or=11% (median value) in 45 patients (52%) and by <11% in 19 (22%), but it decreased or remained unchanged in 23 patients (26%). In contrast, functional class was unchanged or worsened in 59 patients (68%) and improved in only 28 (32%). Similarly, surgery had variable effects on LVEF. LVEF increased by >or=12% (median) in 28 patients (55%) and by <12% in 14 (27%), whereas it decreased or remained unchanged in 9 patients (18%). Functional class was unchanged or worsened in 41 patients (80%) and improved in only 10 (20%). Changes in functional class and LVEF were unrelated for both interventions. Both beta-blockade and CABG surgery improve LVEF in the majority of patients. However, significant improvement in LVEF does not enhance functional capacity consistently in chronic heart failure.     

卡维地洛对慢性心衰患者左心心功能和脑钠肽水平的影响

目的观察卡维地洛对慢性心力衰竭(CHF)患者血浆脑钠肽(BNP)及左心室收缩功能的变化。方法CHF患者87例,分卡维地洛治疗组(B组)44例和常规治疗组(A组)43例。随访6个月,评估两组治疗前、治疗后1个月、3个月及6个月患者心功能指标和血浆BNP浓度。结果治疗后1个月两组血浆BNP水平较治疗前下降(P<0.05),3个月时下降更明显。3个月组间比较有显著性差异(P<0.05);两组患者治疗1个月后左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)及左心室射血分数(LVEF)与治疗前比较均无统计学差异(P>0.05);6个月时的上述指标与治疗前比较均有显著性差异(P<0.05)。两组患者血浆BNP水平与同期测定的左心室舒张末内径呈正相关(r=0.51,P<0.01),与LVEF呈负相关(r=-0.43,P<0.01)。结论卡维地洛能有效地改善CHF患者的心功能;CHF患者BNP水平的变化早于心脏超声指标的变化:血浆BNP水平可以作为治疗心力衰竭的一个可靠观察指标。     

卡维地洛治疗扩张型心肌病心力衰竭临床观察

目的 探讨卡维地洛治疗扩张型心肌病（DCM）心力衰竭临床效果。方法 EK2M心力衰竭患者46例随机分为观察组和对照组。对照组采用常规治疗，观察组在对照组的基础上加用卡维地洛。结果观察组总有效率为87．0％．明显高于对照组的56．5％．差异有统计学意义（P〈0．05）。使用卡维地洛组患者在用药后，心脏缩小，心功能改善，超声心动图指标均有明显改善。结论 采用卡维地洛治疗扩张型心肌病心衰提高了左室射血分数，缩小左室内径．延长患者的寿命。     

慢性收缩性心力衰竭患者左室射血分数与6min步行试验的相关性研究

目的 探讨慢性收缩性心力衰竭(CHF)患者的左室射血分数(LVEF)与6min步行试验(6-MWT)的相关性.方法 将CHF患者180例分为A组60例(LVEF值为30%～35%),B组61例(LVEF值为35%～40%),C组59例(LVEF值为40%～45%).所有患者进行6-MWT的步行距离测定并进行对应分析,同时随访并记录所有入选患者的半年期和1年期的心血管(CV)事件发生情况,并进行对应分析.结果 A、B组6-MWT步行距离均少于C组,差异均有统计学意义(P＜0.05或P＜0.01);且A组亦少于B组,差异有统计学意义(P＜0.05).A、B组CV事件发生率均高于C组,差异均有统计学意义(P＜0.05或P＜0.01);且A组亦高于B组,差异有统计学意义(P＜0.05).结论 CHF患者LVEF值与6-MWT所得的结果有密切的相关性.     

慢性收缩性心力衰竭患者左室射血分数与6min步行试验的相关性研究

目的探讨慢性收缩性心力衰竭(CHF)患者的左室射血分数(LVEF)与6min步行试验(6-MWT)的相关性。方法将CHF患者180例分为A组60例(LVEF值为30%～35%),B组61例(LVEF值为35%～40%),C组59例(LVEF值为40%～45%)。所有患者进行6-MWT的步行距离测定并进行对应分析,同时随访并记录所有入选患者的半年期和1年期的心血管(CV)事件发生情况,并进行对应分析。结果 A、B组6-MWT步行距离均少于C组,差异均有统计学意义(P<0.05或P<0.01);且A组亦少于B组,差异有统计学意义(P<0.05)。A、B组CV事件发生率均高于C组,差异均有统计学意义(P<0.05或P<0.01);且A组亦高于B组,差异有统计学意义(P<0.05)。结论 CHF患者LVEF值与6-MWT所得的结果有密切的相关性。     

贝那普利对慢性充血性心力衰竭患者左心室及血管内皮功能的影响

目的探讨贝那普利对慢性充血性心力衰竭患者左心室及血管内皮功能的影响。方法选取268例慢性充血性心力衰竭,随机分为常规治疗组130例采取常规治疗,贝那普利组138例采取常规治疗联合贝那普利治疗,观察两组治疗前后血管内皮功能测定、左室舒张末内径(LVDd)、左心室射血分数(LVEF)并进行比较。结果两组治疗后FMD、左室舒张末内径、射血分数比较差异有统计学意义(P<0.05)。结论慢性充血性心力衰竭应用贝那普利可以有效的逆转左室重塑,改善左心室功能、血管内皮功能,改善血流动力学,减轻心力衰竭,改善患者的生活质量。     

卡维地洛治疗慢性心力衰竭

目的观察卡维地洛治疗慢性心力衰竭患者的疗效和安全性。方法将慢性心力衰竭患者42例随机分为卡维地洛治疗组23例和对照组19例，两组均给予常规处理，治疗组加用卡维地洛。观察治疗前及治疗3个月后心功能改善情况。结果总有效率治疗组91．3％．对照组73．7％，两组间差异有显著意义（P〈0．05）；治疗组心功能改善情况及左室射血分数（LVEF）指标提高情况均显著优于对照组。结论卡维地洛是一种治疗慢性心力衰竭的理想用药。     

全方向M型超声心动图对糖尿病心肌病患者左心室收缩功能的研究

目的 探讨全方向M型超声心动图在评价糖尿病心肌病（DCM）左心室心肌局部收缩功能中的效果。方法选择62例DCM患者（研究组）、54例正常人（对照组）作为研究对象,采集各组左心室短轴16个节段的全方向M型超声心动图曲线,分别于收缩期和舒张期测量心内膜运动速度（Ven）、心外膜运动速度（Vep）及相对应的室壁厚度（D）,计算心肌速度梯度（MVG）并进行对照分析。结果 研究组左心室短轴平面多数节段舒张期的MVG低于对照组,差异有统计学意义（P〈0.05）,研究组收缩期只有少部分节段MVG低于对照组,差异有统计学意义（P〈0.05）。结论 DCM患者心脏整体收缩及舒张功能在正常范围时就可出现局部心肌运动功能异常,全方向M型超声心动图可用于定量评价其局部心肌运动功能的变化。     

扩张型心肌病心力衰竭病人卡维地洛治疗前后的冠脉血流储备评价

目的:利用无创腺苷激发经胸超声多普勒显像对卡维地洛治疗的扩张型心肌病心力衰竭病人冠脉血流储备(CFR)进行评价。方法:入选2004年6月至2005年6月因扩张型心肌病引起的慢性心力衰竭病人31例,在常规药物治疗基础上,加用卡维地洛至目标剂量或最大耐受剂量,治疗6mo。在卡维地洛治疗前后进行腺苷激发经胸超声多普勒显像检查,记录冠脉血流速度(CFV)及冠脉血流速度储备(CFVR),以CFVR评价CFR。结果:卡维地洛治疗前心力衰竭病人静息状态CFV与对照组无显著差别(P>0.05),最大冠脉扩张状态时CFV减低(P<0.05),CFVR较对照组明显下降(2.4±s0.3vs 3.2±0.4, P<0.05);治疗6mo后心力衰竭病人静息状态下CFV无明显改变(P>0.05)、最大充血状态时CFV升高(P<0.05),CFVR增加(2.7±0.3 vs 3.2±0.4,P<0.05);治疗后心力衰竭组CFV及CFVR与对照组比较仍有显著差别。结论:非选择性β受体阻滞剂卡维地洛能够改善扩张型心肌病心力衰竭病人的冠脉CFR,这可能也是β受体阻滞剂有效治疗扩张型心肌病的作用机制之一。     

比索洛尔和卡维地洛治疗慢性心力衰竭疗效比较

目的分析比较比索洛尔和卡维地洛治疗慢性心力衰竭的疗效。方法将2007年1月至2008年1月收治的78例慢性心力衰竭患者随机分为比索洛尔组40例和卡维地洛组38例,比索洛尔组在继续常规抗治疗的基础上,给予口服比索洛尔治疗;卡维地洛组在继续常规抗治疗的基础上,给予13服卡维地洛治疗。所有患者治疗前后均行超声心动图检查,测量LVEF和左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）,测量血压和心率。治疗一年后,比较两组患者各项指标。结果索洛尔组和卡维地洛组治疗前后超声心动图指标LVEDV、LVESV、LVEF、血压、收缩压和舒张压均具有显著性差异（P〈0．01）;而治疗后两组组间比较只有LVEF比较有显著性差异（P〈0．05）,其余各项指标均不存在显著性差异（P〉0．05）,差异无统计学意义。结论应用比索洛尔和卡维地洛治疗慢性心力衰竭患者,疗效相似,均能显著改善心力衰竭患者的心功能,临床可以推广应用。     

Effects of long-term treatment with verapamil on left ventricular function and myocardial blood flow in patients with dilated cardiomyopathy without overt heart failure

Myocardial blood flow (MBF) abnormalities are present in early stage dilated cardiomyopathy (DCM) and have been attributed to coronary microvascular abnormalities. The favorable effects of verapamil on coronary microcirculation might indicate its use in early stage DCM. We assessed the safety of long-term combination therapy of verapamil and enalapril and its effects on both left ventricular function and myocardial perfusion compared with enalapril alone in 18 patients with DCM (15 men, 3 women; mean age, 50+/-9 years) without overt heart failure (NYHA class I-II). At baseline and after 6 months of randomized treatment with either enalapril (10-20 mg) (nine patients, group 1) or enalapril (10-20 mg) and verapamil (120-240 mg) (nine patients, group 2), left ventricular function was assessed at rest, during handgrip, and during bicycle exercise by equilibrium radionuclide angiography. Mean MBF was measured at rest and after dipyridamole by positron emission tomography (PET) and 13N-ammonia as a flow tracer. At baseline, the two groups had reduced left ventricular ejection fraction at rest, which was further impaired during isometric exercise, but increased at peak bicycle exercise. MBF was similarly reduced in the two groups at rest and during dipyridamole. During treatment, no adverse events occurred in either group. After 6 months there was no significant difference in the main study variables either between the two groups or within each group before and after treatment. Long-term combination therapy with verapamil and enalapril is safe in patients with DCM without overt heart failure. Despite no favorable effect on myocardial perfusion, combined treatment prevented deterioration of left ventricular function, similarly to enalapril alone.     

卡维地洛治疗充血性心力衰竭的疗效观察

目的：观察卡维地洛治疗慢性充血性心力衰竭（CHF）的临床疗效。方法：将90例CHF患者随机分为卡维地洛组（治疗组）和常规治疗组（对照组）各45例。常规治疗组使用洋地黄、利尿剂、血管紧张素转换酶抑制剂、硝酸酯类等药物治疗,卡维地洛组在常规治疗的基础上,加用卡维地洛5mg/d,只要能耐受,尽可能递增到10～20mg/d,疗程24周。每周评定心功能,治疗前、后检查超声心动图,记录不良反应。结果：卡维地洛组心功能分级、左室射血分数（LVEF）明显改善（P〈0.01）,左室舒张末期内径（LVEDD）和收缩末期内径（LVESD）明显降低,与对照组比较,差异有统计学意义（P〈0.01,P〈0.05）。结论：卡维地洛治疗心力衰竭能改善心功能,改善左室重塑,安全有效。     

不同剂量卡维地洛防治高压负荷性心衰幼鼠心室重构

目的 观察不同剂量卡维地洛对高压负荷性心衰幼鼠心室重构的防治作用.方法 采用腹主动脉缩窄术建立慢性心力衰竭(CHF)模型,36只存活雄性5周龄Wistar幼鼠随机分组:(1)CHF对照组(n=8);(2)大剂量卡维地洛组(10 mg·kg-1·d-1,n=10);(3)中剂量卡维地洛组(1 mg·kg-1·d-1,n=10) ;(4)小剂量卡维地洛(0.1 mg·kg-1·d-1,n=8);另设假手术对照组.直接灌胃给药,给药4周后行高频超声、血流动力学、心脏病理分析、心肌细胞凋亡及其检测血清中脂质过氧化物(LPO)和超氧化物歧化酶(SOD)含量.结果 与假手术组比较,CHF组左室收缩末期内径(LVESD)、室间隔舒张末期厚度(IVSTd)、室间隔收缩末期厚度(IVSTs)、左室后壁舒张末期厚(LVPWTd)、左室后壁收缩末期厚度(LVPWTs)左、右心室相对重量(LVRW,RVRW)、收缩压(SBP)、舒张压(DBP)、左室收缩压(LVSP)、左室舒张末压(LVEDP) 、凋亡指数(AI) 、LPO均显著升高(P＜0.01),左室舒张末期内径LVEDD也明显升高(P＜0.05).左室短轴缩短率FS、左室射血分数EF、左室内压最大收缩率( dp/dtmax) 、左室内压最大舒张率(-dp/dtmax) 、SOD均显著降低(P＜0.01).与CHF组比较,卡维地洛组LVEDD、LVESD、IVSTd、IVSTs、LVPWTd、LVPWTs、LVRW、RVRW、SBP、DBP、LVSP、LVEDP、AI、LPO均呈剂量相关性下降,以大中剂量下降明显(P＜0.05或P＜0.01),FS、EF、 dp/dtmax、-dp/dtmax、SOD均显著升高(P＜0.01).结论 卡维地洛大、中、小剂量均能有效防治幼鼠CHF发展中的心室重构,改善血流动力学和心功能,阻止心肌细胞凋亡和清除氧自由基;小剂量有效,大剂量更佳.     

卡维地洛联合螺内酯对慢性心力衰竭患者心功能的影响

目的 探讨卡维地洛联合螺内酯对慢性心力衰竭(Chronic heart failure,CHF)患者心功能的影响。方法 选择200例诊断为CHF的患者作为研究对象,采用随机数字表法平均分为观察组与对照组,在常规治疗的基础上分别给予卡维地洛联合螺内酯治疗与单独卡维地洛治疗。随访观察6月,比较两组患者心脏功能、血浆脑钠肽(Brain Natriuretic Peptide,BNP)及谷胱甘肽过氧化物酶(Glutathioneperoxidase,GSH-PX)的差异。结果 观察组总有效率93.0%明显高于对照组84.0%,差异有统计学意义(P<0.05)。治疗后两组LVEF、LVEDD及BNP均较治疗前降低,而LVESD及GSH-PX较治疗前升高,差异有统计学意义(P<0.05);观察组较对照组改善更明显,差异有统计学意义(P<0.05)。结论 卡维地洛联合螺内酯治疗CHF可以更好改善患者心功能,抑制心肌重塑,降低心衰指标。