苯那普利治疗小儿充血性心力衰竭疗效观察

目的 观察苯那普利治疗小儿充血性心力衰竭的疗效。方法 将６０例患儿随机分为两组，对照组（２９例）给予地高辛、利尿剂、部分加用血管扩张剂等药物治疗。治疗组在上述治疗基础上加用苯那普利。结果 治疗组，显效１６例，有效１２例。有效率９０．３％；对照组显效１１例，有效９例，有效率６９．０％。治疗组疗效优于对照组。结论 苯那普利是目前治疗小儿充血性心力衰竭的有效药物。     

倍他乐克治疗慢性心力衰竭疗效观察

目的观察与评估倍他乐克治疗慢性充血性心力衰竭的疗效。方法61例心脏轻、中度慢性充血性心力衰竭的患者随机分为两组。对照组接受常规抗心力衰竭治疗;治疗组在常规治疗基础上加服倍他乐克,共治疗12周。结果治疗组：显效8例,显效率25.8%,有效20例,有效率64.5%,无效3例,总有效率90.3%。对照组：显效5例,显效率16.7%,有效17例,有效率56.7%,无效7例,总有效率73.3%。治疗组总有效率明显高于对照组,差异有显著性（P〈0.05）。结论心力衰竭常规治疗基础上加服倍他乐克对改善心力衰竭症状疗效显著。     

卡托普利联合地高辛与安体舒通治疗慢性充血性心力衰竭疗效观察

目的：比较地高辛、安体舒通与卡托普利、地高辛、安体舒通治疗慢性充血性心力衰竭（CHF）的临床疗效。方法：将慢性充血性心力衰竭病人60例随机分成地高辛、安体舒通对照组和卡托普利、地高辛、安体舒通治疗组观察总有效率。结果：治疗组32例,有效30例,有效率93．7％;对照组28例,有效20例,有效率71．4％;两组结果差异有显著性。结论：血管紧张素转换酶抑制剂的使用显著提高了治疗CHF的成功率,是近年来治疗CHF传统方法的重大突破。     

苯那普利治疗小儿充血性心力衰竭疗效观察

目的 观察苯那普利治疗小儿充血性心力衰竭的疗效.方法 将60例患儿随机分为两组,对照组(29例)给予地高辛、利尿剂、部分加用血管扩张剂等药物治疗.治疗组在上述治疗基础上加用苯那普利.结果 治疗组,显效16例,有效12例.有效率90.3%;对照组显效11例,有效9例,有效率69.0%.治疗组疗效优于对照组.结论 苯那普利是目前治疗小儿充血性心力衰竭的有效药物.     

卡托普利与倍他乐克联合治疗充血性心力衰竭的临床疗效评价

目的：评价常规强心、利尿基础上，卡托普利、倍他乐克治疗充血性心力衰竭的疗效。方法：选择慢性充血性心力衰竭（CHF）64例，随机分组：观察组（n=32)，常规治疗基础上，加用卡托普利、倍他乐克，疗程观察4－6wk。对照组（n=32)为常规观察组。结果：观察组心功能改善I－Ⅱ级以上为有效，按照YNHA心功能分级，28例有效，占87．5％，对照组19例有效，占59．4％。观察组的收缩压、舒张压、心率较对照组明显下降（P＜0．01），左室射血分数上升（P＜0．01）。结论：强心、利尿基础上加用卡托普利和倍他乐克治疗，能有效地改善CHF患的心功能，疗效优于常规治疗。     

倍他乐克治疗慢性充血性心力衰竭

目的 观察倍他乐克治疗慢性充血性心力衰竭的疗效.方法 将82例慢性充血性心力衰竭患者,随机分为治疗组42例和时照组40例,观察两组的疗效.结果 治疗组心功能明显改善,治疗组显效26例(61.91%),有效12例(28.57%),无效4例(9.52%),总有效率90.48%;对照组显效16例(40.00%),有效8例(20.00%),无效16例(40.00%),总有效率60.00%.两组比较P<0.05.结论 倍他乐克治疗慢性充血性心力衰竭疗效好,值得临床推广.     

心脉隆注射液治疗慢性心力衰竭的疗效观察

目的：观察心脉隆注射液治疗慢性充血性心力衰竭患者的疗效。方法：将61例慢性充血性心力衰竭患者按就诊顺序随机分为治疗组31例和对照组30例,对照组给予常规治疗,治疗组则在此基础上加用心脉隆5mg,kg＋5％G．S．250ml静脉滴注,每天2次,5d为1个疗程。疗程结束时比较心功能改善情况。结果：治疗组总有效率为93．5％,明显优于对照组的66．7％（P〈0.05）。结论：心脉隆治疗慢性充血性心力衰竭疗效显著,不良反应少。     

中医药治疗慢性充血性心力衰竭的临床疗效分析

目的探讨采用中医药方法治疗慢性充血性心力衰竭的临床疗效,为在临床实践中选择有效的方法治疗慢性充血性心力衰竭提供中医理论基础,用以指导临床治疗。方法选取2010年11月至2012年10月来我院治疗的慢性充血性心力衰竭患者共有162例,随机分成治疗组和对照组两组各81例。将治疗组采用的中医药辨证治疗方法与对照组采用芪苈强心胶囊的治疗方法进行疗效的观察,并比较两组患者在治疗前后的临床疗效。结果治疗组患者的临床疗效明显优于对照组,其中治疗组显效49例（60．49％）,总有效率高达90．12％;对照组显效32例（39．51％）,总有效率为70．37％,且经统计学处理有显著差异性（P〈0．05）。结论采用中医方法治疗慢性充血性心力衰竭疗效比较明确,不仅可以改善患者的心脏功能和提高运动耐受量,还能够降低炎性反应。     

硝普钠联合芪苈强心胶囊治疗慢性充血性心力衰竭临床观察

目的探讨硝普钠联合芪苈强心胶囊治疗慢性充血性心力衰竭的临床治疗效果。方法选择本院收治的112例慢性充血性心力衰竭患者作为研究对象,随机分为对照组和观察组,对照组采用硝普钠进行治疗,观察组在对照组基础上加用芪苈强心胶囊治疗,观察两组临床治疗效果。结果观察组显效32例,有效19例,无效5例,总有效率91.07%;对照组显效19例,有效18例,无效19例,总有效率66.07%,差异具有统计学意义（P〈0.05）。结论采用硝普钠联合芪苈强心胶囊治疗慢性充血性心力衰竭的治疗效果优于单纯使用硝普钠治疗效果,值得在临床上大力进行推广。     

卡托普利联合美托洛尔治疗58例社区慢性心力衰竭临床疗效观察

目的：讨探卡托普利与美托洛尔联合用药在治疗慢性充血性心力衰竭（CHF）的临床疗效。方法：将CHF患者随机分为观察组58例和对照组58例。对照组常规给予地高辛和利尿药物治疗,观察组在常规治疗的基础上．加用卡托普利与美托洛尔。结果：疗程结束后观察组与对照组总有效率分别为84.48％和62．06％,两组比较,差异有统计学意义（P〈0．05）;治疗组与对照组左室收缩末期内径、左室舒张末期内径、左室射血分数比较,差异均有统计学意义（P〈0．01）。结论：卡托普利联合美托洛尔治疗慢性充血性心力衰竭临床疗效确切。     

Role of digoxin in right ventricular failure due to chronic cor pulmonale

The effect of digoxin in the treatment of decompensated chronic cor pulmonale was investigated in a randomized double-blind, cross-over, placebo-controlled trial. A total of 34 successive patients with evident right heart failure were included in the study. The mean maintenance daily dose of digoxin was 0.30 +/- 0.03 mg with the mean serum level of 1.7 +/- 0.7 nmol/L. The severity of heart failure was assessed according to a clinicoradiographic scoring system (Heart Failure Score). The heart failure worsened during the placebo-period in eight (23.5%) patients (four with atrial fibrillation, two with a third heart sound (S3), one with a cardiothoracic ratio of more than 0.5 and one with sinus rhythm). By regression analysis, the heart failure significantly worsened only in the subgroup of patients with atrial fibrillation. Digoxin was successfully (without worsening of the heart failure) discontinued in 26 (76.5%) patients. No significant improvement was observed in the patients with S3 gallop. It was concluded that digoxin had no beneficial effect in chronic cor pulmonale patients with heart failure, except in those with atrial fibrillation.     

Decreased renal clearance of digoxin in chronic congestive heart failure

Summary Renal digoxin clearance was compared in patients suffering from atrial fibrillation with well preserved cardiac function (n=9; salt intake ±170 mmol daily) and patients with chronic congestive heart failure (n=10; salt intake 50 mmol daily and maintenance treatment with diuretics). There was no difference between the groups concering digoxin dosage, creatinine clearance, diuresis or sodium excretion in the urine. Digoxin clearance in chronic heart failure proved to be significantly lower than in atrial fibrillation (48±21 vs 71±36 ml·min^–1, p<0.05), and Cdig/Ccreat was similarly reduced at 0.73±0.15 compared to 1.09±0.27 (p<0.005). Steady state serum digoxin concentration was significantly higher in patients with congestive heart failure (1.44±0.47 vs 0.87±0.33 µg·l^–1, p<0.01). Chronic congestive heart failure is a state with reduced digoxin clearance by the kidney, which could lead to digoxin intoxication not explicable by overdose, reduced renal function or the effect of interacting drugs.     

缬沙坦和美托洛尔联合治疗慢性心功能不全患者阵发性心房颤动

目的探讨缬沙坦和美托洛尔对慢性心功能不全患者阵发性心房颤动的影响。方法将138例慢性心功能不全患者阵发性房颤随机分为：胺碘酮组（Ⅰ组）、胺碘酮＋缬沙坦组（Ⅱ组）、胺碘酮＋美托洛尔组（Ⅲ组）、胺碘酮＋缬沙坦＋美托洛尔组（Ⅳ组）,治疗随访2年,比较四组治疗前后左心房内径,窦性心律维持率。结果 （1）Ⅰ组和Ⅲ组左心房内径均大于Ⅱ组和Ⅳ（P〈0.05）,而Ⅰ组和Ⅲ、Ⅱ和Ⅳ组的比较差异无统计学意义。（2）Ⅰ、Ⅱ、Ⅲ、Ⅳ组的窦性心律维持率Ⅰ组低于Ⅱ、Ⅲ和Ⅳ组（P〈0.05）。结论缬沙坦和美托洛尔联合治疗能减少慢性心力衰竭患者阵发性心房颤动的复发,缬沙坦和美托洛尔联合治疗可显著减慢左房的扩大。     

小剂量地高辛合并倍他乐治疗持续性房颤疗效观察

目的 :观察用小剂量地高辛和倍他乐克控制持续性房颤的心室率或转复窦性心律的有效性及安全性。方法 :用单盲安慰剂对照试验对所选病例分为四组 (地高辛组、倍他乐克组、小剂量地高辛和倍他乐克组、安慰剂组 ) ,进行疗效对比。结果 :小剂量地高辛和倍他乐克组观察持续性房颤转复疗效 ,25例患者有6例转复为窦性心律 ,与安慰剂组对照 ,P<0 01 ,同时观察该组控制心室率的疗效为94 7 % ,该组不良反应观察有1例患者出现频发室早、短阵室速 ,停药后消失。结论 :小剂量地高辛和倍他乐克治疗持续性房颤疗效显著。     

雷米普利治疗慢性充血性心衰的临床观察

目的:比较雷米普利、地高辛、利尿剂合用与地高辛、利尿剂合用对慢性充血性心力衰竭(CHF)患者心功能、左室射血分数(LVEF)、左室舒张末期内径(LVED)的影响。方法:110例CHF患者随机分为两组,分别接受雷米普利、地高辛、利尿剂(雷米普利组)及地高辛加利尿剂(对照组),治疗3个月。结果:雷米普利组心功能明显改善,LVED由(6 8.2±4.3)mm减少到(60.1±3.3)mm,LVEF由34.7%±8.9%增加到43.4%±9%,治疗前后比较,P均<0.01,对照组心功能明显改善,但LVED、LVEF无明显变化。结论:雷米普利组治疗CHF患者,对降低LVED、提高LVEF疗效较好。     

Maintenance digoxin after an episode of heart failure: placebo-controlled trial in outpatients.

The need for maintenance digoxin treatment was assessed in a double-blind, variable-dose, crossover comparison with placebo. Forty-six outpatients who had been prescribed the drug for heart failure were studied; 33 were in sinus rhythm and the remainder in atrial fibrillation. Mean serum digoxin concentrations in those with sinus rhythm averaged 1-33 nmol/l, but a lower concentration, averaging 0-97 nmol/l, was accepted in those with atrial fibrillation as six of them developed bradycardia. Sixteen of the 46 patients deteriorated on placebo, and eight completely recovered when digoxin was reintroduced; in the remainder additional diuretics were required temporarily. Spirometric values deteriorated on changing to placebo whether or not the patient showed clinical evidence of recurrence of heart failure. In a separate study of nine patients who showed no clinical evidence of deterioration on placebo, reintroduction of digoxin caused a shortening of left ventricular ejection time, which persisted for at least a month. This suggests that the inotropic response to digoxin is sustained during maintenance treatment.     

NSAIDs, corticosteroids and atrial fibrillation?

Evidence that a number of drugs can cause atrial fibrillation has been accumulating since the 2000s. A case-control analysis of a UK general medicine database showed statistically significant increases in the risk of chronic atrial fibrillation in patients taking NSAIDs, after as little as one month of treatment. When NSAID treatment lasted more than 30 days, the incidence was 9.4%, versus 4.7% in the control group, corresponding to a relative risk (RR) of 1.57 (95% confidence interval (95% CI): 1.15 to 2.15). Similar results were found in patients with no history of heart failure. A Danish case-control study yielded similar results. In the UK case-control study, a statistically significant increase in the risk of chronic atrial fibrillation was found in patients taking corticosteroids (5% versus 1.4% in the control group, RR=2.5, 95% CI: 1.6 to 4). The risk increased with the dose. Another Danish case-control study showed that hospitalisation for atrial fibrillation or flutter was twice as frequent among patients exposed to corticosteroids. In contrast, trials in which corticosteroids were given shortly after cardiac surgery, a highly specific setting, showed a decreased risk of atrial fibrillation. In practice, the risk of atrial fibrillation should be taken into account before deciding whether or not to prescribe a corticosteroid or an NSAID, especially to a patient with known risk factors for atrial fibrillation. The heart rate of treated patients should be closely monitored.     

静脉注射胺碘酮治疗老年充血性心力衰竭伴房颤

目的观察静脉注射胺碘酮治疗老年充血性心力衰竭并发心房颤动的有效性及安全性。方法对56例充血性心力衰竭伴房颤患者,给予胺碘酮150mg,15～20min后无效再给予75mg,之后以0．5～1．0mg/min静脉滴注24h(24h总量＜1200mg)。结果平均负荷量为150～300(170±38)mg,38例转为窦性心律,转复率67．9%,18例仍为房颤,但心室率下降为100次/min以下,不良反应发生率10．7%,无1例心功能恶化。结论静脉注射胺碘酮治疗老年充血性心力衰竭并心房颤动是有效和安全的。     

Evaluation of a sex-based difference in the pharmacokinetics of digoxin

STUDY OBJECTIVE: To determine whether a sex-based difference in digoxin pharmacokinetics exists in patients receiving long-term digoxin therapy for chronic heart failure or atrial fibrillation. DESIGN: Single-center, retrospective review of medical records. SETTING: University-based teaching hospital and outpatient clinic. PATIENTS: Sixty-seven adults (32 men, 35 women) with chronic heart failure or atrial fibrillation who were receiving digoxin therapy. MEASUREMENTS AND MAIN RESULTS: Serum digoxin concentrations and daily digoxin doses were obtained from patients' medical records. Daily doses were adjusted for patients' actual and ideal body weight and body mass index (BMI). The ratio between the serum digoxin concentration and each of the adjusted daily doses of digoxin was compared between men and women. The mean +/- SD serum digoxin concentration was 0.85 +/- 0.51 ng/ml for men compared with 1.02 +/- 0.51 ng/ml for women. Mean +/- SD unadjusted doses of digoxin were 0.180 +/- 0.063 and 0.164 +/- 0.059 mg/day for men and women, respectively; the difference was not statistically significant. Ratios of serum digoxin concentration to daily digoxin doses did not differ by sex when doses were estimated with actual or ideal weight. Only the ratio of the digoxin concentration to the BMI-adjusted dose was significantly different between men and women (0.14 +/- 0.09 and 0.19 +/- 0.11, respectively, p<0.05). CONCLUSION: Sex-based differences in digoxin pharmacokinetics were absent when actual or ideal body weight was used. However, the ratio of serum digoxin concentration to daily digoxin dose adjusted for BMI differed by sex. Because digoxin is distributed to lean body mass, use of the BMI could have overadjusted body weight, leading to inaccurate pharmacokinetic assumptions and calculations. The pharmacokinetics of digoxin do not appear to differ by sex.     

慢性充血性心力衰竭伴持续性房颤患者心室率控制的疗效观察

目的:观察慢性充血性心力衰竭(CCHF)伴持续性快速房颤(AF)患者治疗中不同心室率控制水平的临床疗效及心功能变化。方法:将CCHF伴持续性快速AF患者90例,随机分为对照组45例与治疗组45例。两组常规治疗,治疗组患者心室率控制在静息55~70 min-1,活动后≤90 min-1;对照组患者心室率控制在静息71~85 min-1,活动后≤110 min-1,治疗6个月。观察治疗前和治疗后6个月时的临床症状、指标变化。结果:两组治疗后临床症状、左心室舒张末期直径(LVEDD)、左心室射血分数(LVEF)、6分钟步行距离(6-MWT)较治疗前改善(P<0.05),且治疗组优于对照组(P<0.05)结论:CCHF伴持续性快速AF患者治疗中心室率控制在较低水平能更显著改善临床症状及心功能。