卡维地洛治疗顽固性充血性心力衰竭疗效观察

2002年5月～2003年6月，我们对卡维地洛治疗顽固性心力衰竭的疗效进行了观察，现报告如下。     

倍他乐克治疗顽固性心力衰竭病人70例疗效观察

目的　观察 β -受体阻滞剂倍他乐克对顽固性心力衰竭的疗效。方法　将顽固性心力衰竭患者 70例随机分为治疗组和对照组 ,两组年龄、心衰病程、原发病及心功能分级均具有可比性。在常规抗心衰治疗中 ,治疗组加服倍他乐克片剂 ,从小剂量 6 2 5mg/d开始 ,缓慢加量至有效量或达 2 5～ 5 0mg/d。 4周后观察NYHA心功能分级、左室射血分数 (LVEF)、血压、心率和 2 4h室性早搏 >2 0 0 0次的发生率、病死率及副作用等。结果　治疗组较对照组NYHA心功能分级、左室射血分数均有明显改善 ;血压、心率明显降低 ;室性早搏 >2 0 0 0次 / 2 4h的发生率、病死率明显下降。结论　在常规抗心衰治疗顽固性心力衰竭的基础上加用倍他乐克可明显改善患者的心脏功能 ,提高患者的生活质量 ,并能减少室性早搏的发生率 ,副作用小 ,可作为顽固性心力衰竭治疗的首选辅助用药。     

强心利尿剂治疗老年难治性心力衰竭30例

<正> 本文采用强心利尿合剂(多巴酚丁酚胺,多巴胺,酚妥拉明和速尿)对30例老年难治性心衰进行治疗.收到了较好的效果.现报如下.1.资料与方法1.1.对象选择本院住院老年患者60例,均往临床及有关检查确诊,并符合难治性心衰标准:(1)有心脏病晚期临床表现和心衰难控制的诱因;(2)常规的强心,利尿及扩张血管等治疗2周无效.随机分为治疗组30例,对照组30例.治疗组:男20例,女10例,年龄60～78岁,平均66.岁;心功能(CNYHA分级,下同)Ⅲ级10例Ⅳ级20例;冠心病10例,扩张型心肌病6例,高心病5例,肺心病5例,风心病4例.对照组:男22例,女8例,年龄60～78岁,平均65.5岁.心功能Ⅲ级11例,Ⅳ级19例冠心病10例,扩张型心肌病6例,高心病5例,肺心病6例,风心病3例.     

强心利尿剂治疗肺心病难治性心衰

临床资料1.病例选择　自 1999年 1月至 2 0 0 2年 6月收治肺心病难治性心衰患者 2 1例 ,男 15例 ,女 6例 ;有咳嗽、咳痰、喘息、紫绀、肺底湿罗音、桶状胸、肝瘀血及下肢浮肿表现。经 ECG、X线胸片和临床症状体征 ,确诊为肺心病伴心衰。患者经休息、吸氧、限盐、抗感染、解痉平喘 ,纠正水电解质酸碱平衡失调及应用洋地黄、利尿剂及扩血管药物等治疗 ,心衰没有明显缓解 ,心功能仍处于 ～ 级。2 .治疗(1)药物组成及用法 :5 % GS 2 5 0 ml加多巴胺 4 0 mg、加多巴酚丁胺 2 0 mg、加酚妥拉明 2 0 mg、加速尿 4 0 mg、加 10 % kcl5 ml、静滴…     

静脉滴注呋塞米治疗顽固性心力衰竭的疗效观察

目的探讨持续静脉滴注呋塞米（速尿）治疗顽固性心衰的疗效是否优于间歇静脉注射。方法将26例顽固性心衰的患者随机分为两组，持续静脉滴注组（静脉滴注组13例）和静脉注射组（13例）。静脉滴注组持续静脉滴注速尿200mg，静脉注射组每日两次间歇注射速尿100mg，均持续3d。观察两组呼吸困难程度，全身水肿情况，监测体重、血压、心率、血电解质和肾功能。结果静脉滴注组呼吸困难明显好转，水肿显著消退，体重、心率显著降低（P〈0．05），每日尿量均大于静脉注射组。结论持续静脉滴注速尿治疗顽固性心衰疗效明显优于静脉注射方式，并可显著改善利尿剂抵抗。     

温阳强心汤治疗慢性心力衰竭30例疗效观察

目的观察温阳强心汤治疗慢性心力衰竭治疗效果.方法所有的病例均在治疗原发病,吸氧,低盐的基础上均给予常规强心、利尿、扩血管等综合治疗,观察组加用温阳强心汤.结果观察组总有效率为93.34%,对照组为76.67%,两组比较有统计学意义(P<0.05).结论温阳强心汤治疗心力衰竭远期疗效可靠,提高病人的生活质量,延长了病人的生存期.     

米力农联合小剂量多巴胺治疗顽固性心力衰竭疗效观察

2005年1月～2009年5月,我们采用米力农联合小剂量多巴胺治疗顽固性心力衰竭（心衰）患者60例,取得较好疗效。现报告如下。     

依那普利治疗慢性心力衰竭36例疗效观察

1998年3～8月，我院采用依那普利治疗慢性心力衰竭(CHF)36例。随访5年，效果良好。现报告如下。     

通心络胶囊治疗顽固性心力衰竭的疗效观察

我院自 1999年 3月～ 2 0 0 0年 11月 ,使用通心络胶囊辅助治疗顽固性心衰 4 2例 ,取得满意疗效 ,现报告如下。1　资料与方法1.1　对象我院 1999年 3月至 2 0 0 0年 11月收治顽固性心衰病人共 4 2例 ,男 2 4例 ,女 18例 ,年龄 4 6～ 82(平均 66)岁 ;其中扩张型心肌病 10例 ,冠心病 13例 ,高血压心脏病 6例 ,高血压心脏病并冠心病 7例 ,风湿性心脏病 6例 ;按纽约心脏协会 (NYHA)心功能分级均为 级。1.2　方法所有患者经卧床休息 ,低盐饮食、给氧 ,足量洋地黄 ,利尿 ,扩血管 ,解除诱因 ,积极治疗 1周后心功能均无明显改善。加用通心络胶囊 …     

美托洛尔辅助治疗慢性心力衰竭36例疗效观察

2005年1月～2006年4月,我们采用美托洛尔辅助治疗慢性稳定型心力衰竭36例,效果满意。现报告如下。     

左西孟旦治疗难治性心衰患者的疗效观察

目的：本研究通过对左西孟旦和传统临床治疗心衰药物的心衰疗效观察,评价其临床疗效及安全性。方法：选择难治性心衰患者64例,随机分成左西孟旦组和常规治疗组各32例,两组均给予常规抗心衰药物治疗,左西孟旦组在此基础上给予左西孟旦治疗,常规治疗组给予多巴酚丁胺治疗,对比治疗前后两组的心功能分级、左室射血分数（LVEF）、每搏量（SV）及血浆N末端B型利钠肽前体（NT-proBNP）水平的变化,同时观察药物不良事件的发生率。结果：左西孟旦组心功能改善总有效率明显高于常规治疗组（90.6%比71.9%,P〈0.05）;治疗后与常规治疗组比较,左西孟旦组LVEF[（35.5±7.8）%比（39.2±6.9）%]、SV[（72.0±1.8）ml比（77.6±1.2）ml]明显提高（P〈0.05）,NT-proBNP[（1562±836）μg/L比（865±310）μg/L]水平显著降低（P〈0.01）。左西孟旦组的不良反应发生率明显低于常规治疗组（6.3%比25%,P〈0.01）。结论：左西孟旦对于难治性心衰患者,可显著改善心功能,降低N末端B型利钠肽前体,安全性好。     

Potent diuretic effects of prednisone in heart failure patients with refractory diuretic resistance

BACKGROUND: Refractory congestive heart failure (CHF) with diuretic resistance is life-threatening and predicts a short life expectancy. Glucocorticoids have been proven to have potent diuretic effects in animal studies; however, their efficacy in CHF patients with diuretic resistance is not known. METHODS: Thirteen CHF patients with significant volume overload and diuretic resistance who failed to respond to a conventional sequential nephron blockade therapeutic strategy; that is, the coadministration of a thiazide (hydrochlorothiazide) and spironolactone, in combination with loop diuretics, were studied. Prednisone (1 mg/kg daily) was then added to standard care, with other medications unchanged, to determine diuretic efficacy in these CHF patients. Variables included body weight, urine volume, serum electrolytes and renal function. RESULTS: Adding prednisone resulted in striking diuresis with a mean (+/- SD) body weight reduction of 9.39+/-3.09 kg. Prednisone significantly decreased serum creatinine by 52.21+/-48.68 mumol/L and increased glomerular filtration rate by 33.63+/-15.87 mL/min/1.73 m(2) compared with baseline. All patients were discharged from hospital with improved clinical status and renal function, and 11 patients remained alive in the long term. The main side effect of prednisone appeared to be hyperglycemia in diabetic patients. CONCLUSIONS: The present study demonstrated that prednisone can rapidly eliminate volume overload and improve clinical status and renal function in CHF patients with diuretic resistance. Further prospective randomized clinical studies are warranted to confirm its clinical efficacy.     

氯沙坦与贝那普利联合治疗充血性心力衰竭的疗效观察

肾素-血管紧张素系统（RAS）在充血性心力衰竭（CHF）的发病过程中起着重要作用已成为共识.血管紧张素转化酶抑制剂（ACEI）是作用于RAS起作用从而治疗CHF,并已成为治疗CHF的基础用药.血管紧张素受体1拮抗剂（ARB）作用于血管紧张素受体1而发挥作用,且耐受性好.我们试用ARB中的氯沙坦与ACEI中的贝那普利联合治疗CHF,疗效较好,现报道如下.     

硝普钠与多巴胺联合应用治疗顽固性心力衰竭50例

目的：观察硝普钠与多巴胺联合应用治疗顽固性心力衰竭的临床效果。方法对50例顽固性心力衰竭患者给予静脉微泵硝普钠与多巴胺联合治疗,观察患者心率、血压及心功能改善情况。结果显效31例,有效14例,无效5例,总有效率为90.0％。结论硝普钠与多巴胺联合治疗顽固性心力衰竭临床有较好的疗效,未见明显毒副反应,可在临床推广使用。     

Difficult cases in heart failure: Ventricular resynchronization in refractory heart failure

The use of a multisite transvenous pacemaker in a patient with refractory heart failure who experienced short-term symptomatic improvement is described. The improvement in heart failure symptoms was most likely related to resynchronization of atrioventricular and interventricular asynchrony. Large, multicenter, randomized trials of this technology are being performed to evaluate the importance of this therapeutic modality in the treatment of heart failure. (c)2000 by CHF, Inc.     

Diuretic treatment and diuretic resistance in heart failure.

Diuretic therapy decreases capillary wedge pressure and improves New York Heart Association (NYHA) functional class both in acute and chronic heart failure. In advanced symptomatic heart failure, loop diuretics are generally necessary to improve symptoms of congestion. Diuretic resistance in the edematous patient has been defined as a clinical state in which diuretic response is diminished or lost before the therapeutic goal of relief from edema has been reached. The major causes of diuretic resistance are functional renal failure (prerenal azotemia), hyponatremia, altered diuretic pharmacokinetics, and sodium retention caused by counterregulatory mechanisms intended to reestablish the effective arterial blood volume. Therapeutic approaches to combat diuretic resistance include restriction of fluid and sodium intake, use of angiotensin-converting-enzyme (ACE) inhibitors, changes in route (oral, intravenous) and timing (single dose, multiple doses, continuous infusion) of diuretic therapy, and use of diuretic combinations.     

缬沙坦治疗慢性充血性心力衰竭的疗效观察

目的 观察缬沙坦治疗慢性充血性心力衰竭的疗效。方法 慢性充血性心力衰竭患者61例,随机分为对照组与治疗组。对照组给予常规抗心力衰竭治疗;治疗组在对照组治疗基础上,用缬沙坦80～160mg／d．结果 治疗组临床症状改善总有效率为87．09％,高于对照组73．33％（P〈0．05）;两组治疗后心脏射血分数、B型尿钠肽较治疗前改善（P〈0．01）,且治疗组优于对照组（P〈0．05）;并且病人再发心衰及心血管原因的死亡均减少。结论 缬沙坦在常规治疗心力衰竭基础上能显著改善患者临床症状及心功能,并对心衰患者的二级预防有利。     

顽固性心衰治疗进展

慢性心力衰竭是一种复杂的临床综合征,是各种心脏病最终的归宿,死亡率高。各种心血管疾病一旦发展到心力衰竭阶段,多种病因和病理生理机制交错在一起,将极大增加诊治难度。心衰患者经“传统”疗法即强心（西地兰等）、利尿（速尿等）、扩张血管（硝普钠等）等综合治疗后,病情不见好转,心功能仍处于Ⅲ～Ⅳ级（NYHA分级）,称为顽固性心衰。其预后差,病情可迅速恶化,传统内科药物治疗极为困难。近年来,基础学科的发展及一些大型临床试验的结果不但使我们进一步了解了心衰的病理生理机制,而且也使心衰治疗的概念发生了根本性的变化。     

Clinical effect of China-made amrinone in the treatment of refractory congestive heart failure

Clinical and hemodynamic studies were carried out in 20 patients suffering from refractory congestive heart failure with invasive technique and non-invasive methods such as tolerance exercise test, 24-hour Holter monitoring, etc. Digitalis was then withdrawn and China-made amrinone (AMR) was administered orally for 15 days. All the indices mentioned above were repeated and each patient served as his own control. The results indicate that AMR can improve hemodynamic parameters as well as exercise tolerance. Holter monitoring revealed no significant increase in arrythmogenic potentiality. The total clinical effective rate was 95%. No severe side effects were found except thrombocytopenia observed in 20% of the patients. It is suggested that China-made AMR is effective in treating refractory congestive heart failure.