L—甲状腺素在充血性心力衰竭治疗中的应用

充血性心力衰竭 (CHF)与甲状腺激素之间的关系日渐引起人们的重视。据国外文献报道 [1～ 3] ,通过增加体内的甲状腺素水平 ,可使 CHF患者心肌收缩力增加 ,心脏舒张功能改善 ,以及外周血管阻力降低。鉴于此 ,我们观察了 CHF患者短期内口服小剂量 L-甲状腺素钠后 ,其甲状腺功能的改善及对心功能的影响 ,以期对甲状腺素在 CHF治疗中的应用价值作出评价。1　资料与方法1 .1　临床资料　 CHF患者 76例 ,男 5 4例、女 2 2例 ,年龄 3 9～ 83岁、平均 6 2± 1 1岁。心功能 NYHA分级 ～ 级。基础心脏病分别为冠状动脉性心脏病 1 4例 ,高血…     

老年慢性充血性心力衰竭患者甲状腺激素水平及小剂量甲状腺素治疗临床观察

目的　探讨老年慢性充血心力衰竭 (心衰 )患者血浆甲状腺激素 (TH)水平与心衰程度的关系及小剂量甲状腺素补充治疗的疗效。　方法　 14 0例老年心衰患者按美国纽约心脏病学会(NYHA)心功能分级分为两组 :A组 :6 0例 ,心功能Ⅰ、Ⅱ级 ;B组 :80例 ,心功能Ⅲ、Ⅳ级。再将B组分为治疗组 5 0例和对照组 30例。A、B两组均常规抗心衰治疗 ,唯治疗组加小剂量甲状腺素片 2 0～4 0 μg/d ,疗程 4周。治疗前后监测血清TH、心率、超声心动图及临床心功能。　 结果　 (1)血清TH水平的变化 :治疗前A、B两组游离T3 (FT3 )分别为 (4 2 2± 0 6 1) pmol/L、(3 0 7± 1 10 )pmol/L ;游离T4(FT4)分别为 (17 10± 3 5 4 )pmol/L、(16 0 3± 1 4 0 ) pmol/L ,均低于正常 ,B组降低更为显著(P <0 0 1,P <0 0 5 ) ;促甲状腺素 (TSH)差异无显著性。治疗后治疗组FT3、、FT4分别升至 (4 95± 2 5 0 )pmol/L、(18 30± 5 88)pmol/L(P <0 0 1,P <0 0 5 ) ,TSH差异无显著性。 (2 )心功能变化 :治疗组左室收缩、舒张功能明显提高 ,左室舒张末期内径缩小 ,临床心功能恢复 1～ 2级 (3例无明显改善 ) ,与治疗前比较P <0 0 1,与对照组比较P <0 0 5。　结论　老年慢性充血性心衰患者存在FT3 、FT4水平的降低 ,经小剂量补充甲状腺     

倍他乐克治疗慢性充血性心力衰竭临床观察

目的：观察倍他乐克治疗慢性充血性心力衰竭（CHF）的临床疗效。方法：44例CHF患加服倍他乐克并与常规治疗组比较，观察临床心功能改善情况。结果：加服倍他乐克组心功能的改善，生活质量提高，心率减慢。血压下降及心脏射血分数改善均优于常规治疗组。结论：慢性CHF患服用倍他乐克能改善心功能，提高生活质量，改善预后，倍他乐克可作为治疗CHF的常规药物。     

小剂量甲状腺素治疗老年重症充血性心力衰竭的临床效果

目的探讨小剂量甲状腺素治疗老年重症充血性心力衰竭(CHF)的临床效果。方法选取2011—2012年我院收治的老年重症CHF患者50例,按照随机数字表法将其分为试验组和对照组,各25例。对照组采取解痉、降压以及强心、吸氧、利尿等综合性治疗,试验组在对照组综合治疗的基础上,使用小剂量甲状腺素治疗。比较两组患者治疗前后甲状腺激素水平,并观察两组患者治疗中所出现的不良反应。结果治疗前两组T3、T4、TSH、血清反T3(rT3)比较,差异均无统计学意义(P0.05);治疗后试验组T3、T4、TSH高于对照组,rT3低于对照组(P0.05)。对照组总有效率为80%(20/25),低于试验组的92%(23/25)(P0.05)。两组患者均未发生呕吐和腹泻等不良反应。结论临床上,大多数老年重症CHF患者合并甲状腺激素改变的情况,对患者进行小剂量甲状腺素补充,能够有效地提高血清中游离甲状腺激素水平,及时地纠正临床症状,且无不良反应发生。     

倍他乐克治疗慢性充血性心力衰竭疗效观察

目的:通过倍他乐克对慢性充血性心力衰竭(CHF)的疗效观察,探讨β受体阻滞剂在CHF中的作用。方法:88例CHF患者在利尿剂、血管紧张素转换酶抑制剂、洋地黄及血管扩张药物治疗基础上加用倍他乐克治疗。初始剂量6.25mg,每日2次,依临床情况每周加倍至目标剂量100mg/d,治疗6个月。观察治疗前后心率、血压、心胸比、左心室舒张未期内径(LVED)、左心室射血分数(LVEF)、心功能的变化及生活质量的改变。结果:治疗后心率、血压、心胸比、LVED均明显降低(P<0.05～<0.01),心功能改善(P<0.05),生活质量提高。结论:倍他乐克治疗CHF安全、有效,副作用少。     

小剂量卡维地洛治疗重度充血性心力衰竭短期临床观察

目的观察小剂量卡维地洛治疗重度充血性心力衰竭(CHF)的临床耐受性和安全性.方法28例重度CHF患者在标准治疗基础上(利尿剂、血管紧张素转换酶抑制剂(ACEI)和洋地黄类制剂等)加用卡维地洛,起始剂量3125mg,2/d,2周后增至625mg,2/d,维持3个月,治疗前后分别对患者心功能(NYHA分级法)、血压、心率、及生化指标进行检测,以评价小剂量卡维地洛治疗重度CHF的耐受性、安全性及疗效.结果应用小剂量卡维地洛治疗3个月后患者心功能较治疗前改善,12例心功能由Ⅲ、Ⅳ级改善为Ⅱ级,心率、左心室舒张末期压下降,不良反应少,对肝肾功能、血糖、血脂、血常规均无影响,耐受性好.结论小剂量卡维地洛治疗重症CHF短期疗效、耐受性及安全性良好.     

短期口服甲状腺素治疗严重慢性充血性心力衰竭的临床疗效观察

目的观察评价甲状腺素对严重慢性充血性心力衰竭(CHF)的近期治疗效果。方法选择71例严重慢性CHF住院病人,随机分为2组,治疗组在常规抗心力衰竭药物治疗的基础上加用甲状腺素。结果 2组病人治疗后心功能和主观症状的改善程度,以及6分钟步行试验距离结果的比较均无显著性差异(P>0.05);仅有治疗组中低T3综合征亚组的6分钟步行试验距离与对照组比较有显著性差异(P<0.05)。结论常规短期口服甲状腺素治疗严重慢性CHF并无显著的临床疗效。但对于CHF合并低T3综合征的病人。甲状腺素的治疗效果是肯定的。     

甲状腺素治疗心力衰竭16例疗效观察

充血性心力衰竭时可出现血清甲状腺激素分泌失衡。有报道甲状腺素在心衰的治疗中有重要作用。我们应用甲状腺素片治疗充血性心力衰竭 16例 ,获得明显疗效 ,总结如下。资料与方法　　 1 临床资料16例病例均为我院心内科住院患者 ,男性 10例 ,女性 6例 ,年龄 2 4～ 72岁 ,平均 5 8 5岁。其中风湿性心瓣膜病6例 ,扩张性心肌病 5例 ,冠心病 3例 ,其他心脏疾病 2例。心衰程度按NYHA分级 ,Ⅳ级者 7例 ,Ⅲ级者 5例 ,Ⅱ级者 4例。2 治疗方法全组患者均给吸氧、强心、利尿及扩血管等药物治疗。在常规治疗基础上加用国产甲状腺素片口服。采用小剂量…     

小剂量左旋甲状腺素治疗重症心力衰竭的疗效

目的:观察小剂量左旋甲状腺素长期治疗重症心力衰竭的疗效及可行性。方法:选择128例重症充血性心力衰竭患者,随机分为观察组和对照组,两组抗心衰基础治疗相似,观察组加服左旋甲状腺素12.5~25 m g/d,对比治疗前后心功能改善情况,6 m in步行试验,血清甲状腺素水平,心率变化,再住院人次,病死率和不良反应。观察6~30个月,每3个月复查相关指标。结果:两组心功能均改善,运动耐量增加,但观察明显优于治疗对照组(P<0.05);血清T3、T4均恢复至正常范围,但其水平观察组升高更明显(P<0.01),两组治疗后心率,病死率无明显差异(P>0.05),但再住院人次,观察组较对照减少49.26%(P<0.01),而且观察组治疗过程无甲亢表现。结论:长期补充小剂量甲状腺素对于慢性重症心力衰竭,不仅能显著改善心功能、生活质量,而且安全。     

Treatment of depression in patients with congestive heart failure

Heart failure is common, and depression is common in heart failure patients, adding substantially to the burden of the disease. There is some evidence for the safe and at least modestly effective use of psychotherapy and antidepressants to treat depression in heart failure patients. Cognitive behavioral psychotherapy and selective serotonin reuptake inhibitors are first line treatments. The efficacy of depression treatment in altering cardiac outcomes in heart failure patients has yet to be established.     

Renal effects of low dose prazosin in patients with congestive heart failure

Activation of the sympathetic nervous system may contributeto the renal vasoconstriction and sodium retention seen in congestiveheart failure. Previous studies in congestive heart failurepatients employing large doses of prazosin that lowered systemicblood pressure have been generally disappointing. The renalhaemodynamic and segmental tubular effects of low non-depressordoses of prazosin (0.25 mg and 0.50 mg) were examined in eightfemale patients with mild to moderate congestive heart failure.Segmental tubular function was assessed by the lithium clearancemethod. Compared to placebo, prazosin caused a significant increasein urinary sodium excretion (from 56±7 to 92±7µmol. min^–1, P<0.01), paralleled by significantincreases in fractional excretion of sodium and lithium. Glomerularfiltration rate and effective renal plasma flow were not alteredby prazosin. Prazosin pre-treatment did not alter any of therenal responses to frusemide treatment (mean dose 85±14mg).This study demonstrates that low non-depressor doses of prazosinhave a clear natriuretic effect in congestive heart failurepatients, which is predominantly established by interferencewith tubular reabsorption.     

Effects of low dose enoximone for chronic congestive heart failure

To examine the short-term hemodynamic and long-term clinical effects of oral enoximone at low doses, 12 patients with severe, chronic congestive heart failure (CHF) were given 1 mg/kg oral enoximone and followed with serial hemodynamic measurements for 24 hours. Control cardiac index was 1.9 +/- 0.5 liters/min/m2 and it increased significantly by 1 hour, with a peak effect at 2 hours to 2.4 +/- 0.4 liters/min/m2 (p less than 0.05). Similarly, wedge pressure, 22 +/- 8 mm Hg at control, decreased to 16 +/- 10 by 1 hour (p less than 0.05). Six of the 12 patients received 1 mg/kg of enoximone on day 1 and 2 mg/kg on day 2. The higher dose of enoximone caused no further improvement in cardiac performance but prolonged the salutary hemodynamic effect. Subsequently, 79 patients (18 in New York Heart Association class III and 61 in class IV) with CHF (ejection fraction 17 +/- 8%) were followed over a 3 year period; the average enoximone dose was 1.7 +/- 0.7 mg/kg 3 times daily. Improvement of at least 1 functional class occurred in 55 patients (70%) at 1 month, 27 patients (34%) at 6 months and 19 (24%) maintained their improvement for over 1 year. Enoximone was discontinued in 20 patients (25%); in 5 (6%) for adverse effects and in 13 patients because of no clinical benefit. Adverse effects occurred in 14 patients (18%); 6% of all patients required discontinuation of drug. Six month survival was 50%, 42% at 1 year and 30% at 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)     

小剂量左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭患者心功能的影响

目的：评估小剂量补充左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭（CHF）患者的影响。方法：选择2010年1月至2012年1月在我院心内科住院确诊伴低T3综合征的CHF患者100例,随机平均分为2组：对照组常规抗心力衰竭药物治疗;治疗组在常规抗心力衰竭药物基础上每目口服1次左旋甲状腺素钠片25μg。随访期6个月,所有研究对象在研究初始及随访结束时均行甲状腺功能包括游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素释放激素（TSH）、甲状腺彩超、B型利钠肽（BNP）、基质金属蛋白酶（MMP）-9水平及左室质量指数（LVMI）检测,并记录两组患者心血管事件及不良反应的发生率。结果：与对照组比较,治疗组BNP、MMP-9水平明显降低,FT3水平升高（P〈0．05）。治疗组患者LVMI及心血管事件发生率较对照组无显著性差异;治疗组无明显不良反应发生。结论：对CHF伴低T3综合征的患者,加用小剂量左旋甲状腺素钠治疗,无明显不良反应,并可明显降低患者血清BNP及MMP-9水平。     

Effect of low dose Amiodarone on the incidence of sudden death in elderly patients with congestive heart failure: a double-bind, placebo-controlled study

To determine if low-dose Amiodarone could reduce sudden death (SD) among patients with congestive heart failure, a prospective, double-blind, placebo-controlled study was conducted. The study group consisted of 46 patients (36 men and 10 women, mean age 71 +/- 5 years) with complex ventricular ectopy documented by 48-hour Holter monitoring. Randomization divided the patients into two treatment groups: the first group received Amiodarone (400 mg/day for 1 week and then 100 mg/day), while the second group received placebo. The drug significantly reduced ventricular arrhythmias, but then was no decrease in incidence of SD. This study demonstrates not only that low-dose Amiodarone can be safely administered to elderly patients with congestive heart failure and it will significantly suppress ventricular arrhythmias, but also that reduction in ventricular arrhythmias and the risk of SD are not linearly related.     

Bolus versus continuous low dose of enalaprilat in congestive heart failure with acute refractory decompensation.

The first dose of angiotensin-converting enzyme (ACE) inhibitors may trigger a considerable fall of blood pressure in chronic heart failure. The response may be dose-related. To determine hemodynamic and systemic oxygenation effects of low-dose enalaprilat, we administered intravenous enalaprilat (0.004 mg/kg) as bolus (group B) or continuous 1-hour infusion (group C) in 20 patients with congestive heart failure due to ischemic heart disease with acute decompensation refractory to inotropic, vasodilator and diuretic therapy. Hemodynamic and systemic oxygenation variables were recorded at baseline (+0 min), +30, +60, +120, +180, and +360 min after the start of intervention. Mean arterial pressure (MAP) (p < 0. 001), mean pulmonary artery pressure (MPAP) (p < 0.001), pulmonary artery occlusion pressure (PAOP) (p < 0.001), oxygen extraction ratio (ER) (p < 0.026) decreased regardless of enalaprilat application. Compared to group B, there was in group C prolonged decrease of MAP, MPAP, PAOP, ER and increase of pulmonary artery oxyhemoglobin saturation in regard to baseline values. Cardiac index, heart rate, central venous pressure and oxygen consumption index did not change. A low dose of intravenous enalaprilat (0.004 mg/kg) can be used to safely improve hemodynamics and systemic oxygenation in congestive heart failure due to ischemic heart disease with acute refractory decompensation.     

隔日口服地高辛治疗老人慢性充血性心力

目的 对比隔日1次口服地高辛0.125 mg或0.25 mg治疗老人慢性充血性心力衰竭的临床疗效.方法 慢性充血性心力衰竭老年患者86例,口服基础治疗药物有依那普利10 mg,每日2次,氢氯噻嗪25 mg,每日2次,氯化钾缓释片1.0 g,每日1次.病人随机分为两组,分别隔日口服地高辛0.125 mg或0.25 mg,用放射免疫法测定血清地高辛浓度,用超声心动图测定左心室射血分数,记录心电图,观察心功能改变,随访6个月.结果 两组治疗6个月后,地高辛稳态血药浓度在高剂量组高于低剂量组[(1.45±0.52)μg/L比(0.97±0.31)μg/L,P<0.01)],理想治疗窗(0.5～0.9 μg/L)病例数在低剂量组多于高剂量组(19/43比4/43,x2=13.354,P=0.000);左心室射血分数(0.47±0.05比0.46±0.05)和心功能分级改善差异无统计学意义(P>0.05),但地高辛中毒在高剂量组有4例,而低剂量组仅1例.结论 地高辛隔日口服治疗老人充血性心力衰竭,剂量0.125 mg与0.25 mg疗效相当,但前者用药较安全.建议根据其血药浓度、肌酐清除率和心功能分级进行个体化用药,以达到最佳疗效.     

老年慢性心力衰竭患者的正常甲状腺功能病态综合征

目的　探讨老年慢性心力衰竭患者中正常甲状腺功能病态综合征的情况及其与老年人病情和预后的关系。方法　运用化学发光免疫法测定老年慢性心力衰竭患者 (6 6例 )及对照组 (30例 )血浆三碘甲状腺原氨酸 (T3 )、甲状腺素 (T4)、游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4)及促甲状腺素 (TSH)水平。结果　心力衰竭患者与对照组比较 ,T3 、FT3 明显降低 ,心力衰竭越重 ,降低越明显。心功能分级标准Ⅳ级患者T4、FT4及TSH较对照组降低明显 ,T4、FT4降低或合并TSH降低者 ,病死率高。结论　老年慢性心力衰竭患者常伴有正常甲状腺功能病态综合征 ,尤其是正常甲状腺功能病态综合征中低T3 低T4综合征为预后不良指标。甲状腺激素有望成为心力衰竭治疗中的一类新型药物。