倍他乐克治疗慢性充血性心力衰竭疗效观察

我院2000年1月-2004年5月收治慢性充血性心力衰竭病人90例。在子常规抗心力衰竭药物治疗的基础上联合应用倍他乐克观察治疗慢性充血性心力衰竭的临床疗效。     

地高辛和倍他乐克联合治疗慢性心力衰竭并发房颤的疗效观察

本文旨在探讨地高辛和倍他乐克联合对慢性充血性心力衰竭并发永久性房颤的临床疗效及其安全性。     

倍他乐克治疗充血性心力衰竭35例疗效观察

目的：探讨倍他乐克在充血性心力衰竭的应用。方法：选择心力衰竭患者65例，随即分为治疗组和对照组，对照组常规给予强心、利尿、扩血管药物治疗。治疗组在上述药物治疗的基础上加用倍他乐克，治疗三周后，评估心功能改善情况。结果：治疗组和对照组，有效率分别为77％和63％，经统计数处理，差异显著。结论：在常规抗心衰药物的基础上加用可明显改善患者的心功能。     

倍他乐克缓释片治疗充血性心力衰竭临床疗效观察

充血性心力衰竭(CHF)是临床常见的综合征,其发病率高,预后差,是导致心血管系统疾病患者死亡的重要原因之一,需积极有效加以控制。近年来实验表明应用倍他乐克治疗心力衰竭的临床疗效肯定[1],而用倍他乐克缓释片治疗充血性心力衰竭的临床研究少有报道。我们用倍他乐克缓释片治疗     

地高辛合并小剂量倍他乐克治疗慢性充血性心力衰竭伴快室率房颤疗效观察

本文对２例慢怀充生心力衰竭（ＣＨＦ）伴快室率房颤（Ａｆ）患者试用地高辛＋小剂是倍他乐克治疗。结果显示；心率（ＨＲ）由１０４．２±１１次／分减慢至８１．３±８次／分，随心率控制心衰亦有改善。提示二药并用，电生理作用相加，对房室抑制制作用增强，使ＨＲ减慢，舒张期延长、心输出量增国。并可防止ＣＨＦ时高水平的儿茶酚胺时心肌的 伤。但应警惕用药过程中发生心动过缓及心衰加重。     

倍他乐克治疗慢性充血性心力衰竭疗效观察

目的：评价倍他乐克治疗慢性充血性心力衰竭的临床疗效。方法：64例慢性充血性心力衰竭患者，随机单盲分成倍他乐克组（治疗组）常规治疗组（对照组）各32例。结果：与对照组比较，治疗组症状缓解，心功能改善、抗心律失常、减少住院率均优于对照组（P〈0．05），两组不良反应均轻微。结论：β受体阻滞剂在改善患者心功能、抗心律失常、增加运动耐量、减少住院率方面作用肯定。     

地高辛与倍他乐克联合治疗快速房颤的临床观察

为观察地高辛与倍他乐克联合治疗快速房颤的疗效，我们将64例心衰合并快速房颤患者随机分为地高辛与倍他乐克治疗组和地高辛对照组。分别观察两组治疗前后心室率、收缩压、舒张压、心功能改变。结果报道如下：     

倍他乐克治疗慢性充血性心衰的临床疗效观察

120例慢性充血性心衰患者随机分为两组，对照组常规使用洋地黄制剂，利尿剂及ACEI，治疗组在对照组基础上加用倍他乐克。治疗6个月后观察结果，两组在改善症状，降低病死率，提高生活质量方面有显著差异，提示倍他乐克治疗慢性充血性心衰，只要从小剂量开始，注意剂量个体化，严密观察，可以安全用药，并取得良好疗效。     

小剂量倍他乐克治疗老年人充血性心力衰竭疗效观察

β受体阻滞剂因其负性肌力作用，长期被认为充血性心力衰竭（CHF）患者的禁用药，近也受临床关注[-3]。本文对老年CHF伴心室率快的患者30例在常现治疗基础加用倍他乐克治疗，现报道如下。1对象与方法1．1对象：CHF30例，男22例，女8例，年龄60～79岁。风湿性瓣膜病变10例，冠心病10例，扩张型心肌病6例，高心病4例。本组患者入院后均常现抗心衰治疗（强心、利尿、血管扩张剂）1周，心衰未纠正，且心室率较快（＞100次／分），按NYHA心功能分级标准，Ⅱ级11例，Ⅲ级19例。1．2方法：本组患者均在抗心衰的基础上，加用倍他乐克，从6．25…     

美托洛尔联合地高辛对快速房颤的临床疗效分析

目的观察美托洛尔联合地高辛治疗房颤的临床疗效和安全性。方法将86例房颤患者随机分为2组,对照组43例单纯给予地高辛治疗,治疗组43例给予地高辛＋美托洛尔治疗,观察2组患者治疗前后心功能、心率和生活质量变化等指标。结果治疗组运动心率、心功能及生活质量改善情况明显优于对照组;治疗组总有效率（90.7%）显著高于对照组（72.1%）,差异均有统计学意义;2组不良反应无显著差异。结论美托洛尔联合地高辛是控制快速房颤心室率安全有效的方案。     

Atrioventricular junction ablation followed by resynchronization therapy in patients with congestive heart failure and atrial fibrillation (AVERT-AF) study design

Atrial fibrillation (AF) and congestive heart failure (CHF) affect millions of patients in the United States. Several studies suggest that AF and in particular the irregular ventricular response might be contributing to the left ventricular dysfunction. Studies that compared pharmacologic rate control to atrioventricular junction (AVJ) ablation followed by right ventricular pacing which restores a regular ventricular response, failed to show an improvement when compared to pharmacological rare control. These results might be explained by the fact that while AVJ ablation restored a regular ventricular response, it subjected patients to the detrimental effects of RV apical pacing. The AVERT-AF trial (Atrio-VEntricular Junction Ablation Followed by Resynchronization Therapy in patients with CHF and AF) is a prospective, randomized, double-blinded, multicenter trial that will be testing the hypothesis that AVJ ablation followed by biventricular pacing significantly improves exercise capacity and functional status compared to pharmacologic rate control in patients with chronic AF and depressed ejection fraction, regardless of rate or QRS duration. A total of 180 patients will be enrolled to test the primary endpoint, which is exercise duration. Patients_enrollment will begin in summer 2006 and is expected to be completed in 2008. The results of this trial should help define the best treatment option for this common arrhythmia in patients with left ventricular dysfunction.     

慢性心力衰竭患者血浆肾上腺升压素和心钠素的变化

目的 观察慢性充血性心力衰竭(CHF)患者血浆肾上腺升压素(ADT)和心钠素(ANP)的变化,以探讨CHF发生发展的病理生理机制.方法 采用特异性放射免疫法检测了45例CHF患者治疗前后和20例正常人ADT和ANP的血浆浓度.结果 治疗前,ADT血浆浓度在心功能Ⅱ级为(29.98±3.56)ng/L、Ⅲ级为(33.45±3.54)ng/L,Ⅳ级为(20.71±3.37)ng/L,心功能Ⅲ级时达到高峰,心功能Ⅳ级时明显下降,并且低于正常对照组(24.89±2.19)ng/L,心力衰竭各亚组与正常对照组比较,差异均有统计学意义(均P＜0.05);经1周药物治疗后,心力衰竭各亚组患者血浆ADT含量下降.治疗前ANP血浆含量在心力衰竭各亚组较对照组明显升高(P＜0.05),心力衰竭各亚组间比较差异亦有统计学意义(均P＜0.05);治疗后,心力衰竭各亚组均下降,Ⅳ级组与治疗前相比差异有统计学意义(P＜0.05),余两组差异无统计学意义(P＞0.05).治疗前ADT和ANP在Ⅱ级组和Ⅳ级组无相关关系,Ⅲ级组有负相关关系(r=-0.46,P=0.04).结论 ADT和ANP共同参与了心力衰竭的病理进程,表明缩血管和舒血管活性肽分子间平衡被打破,反映了心力衰竭的严重程度;短期药物治疗可降低其血浆水平.     

美托洛尔在治疗慢性肺心病心力衰竭中的应用

目的　研究与分析选择性β1受体阻滞剂美托洛尔(倍他乐克)对慢性肺心病心力衰竭(心衰)患者的病 死率、住院率及耐受性方面的疗效。方法　44例重度慢性肺心病心衰患者随机分成两组:对照组20例,给予常规治 疗加维生素B15～60mg/d;治疗组24例,给予常规治疗加倍他乐克6.25～100mg/d,随访1年。结果　随访1年时, 治疗组与对照组对比,在所有预设的病死率研究终点上均明显降低,总死亡数为2例对4例;因心衰恶化死亡数为1 例对3例。另外,与对照组对比,倍他乐克治疗组心衰恶化患者住院率下降64%(P<0.01),患者的心功能(NYHA 分级)改善更明显,不良反应轻微。结论　倍他乐克治疗重度慢性肺心病心衰患者,可降低住院率,改善心功能状态而 且具有良好的耐受性。     

快速心室起搏犬心房颤动模型研究

目的建立快速起搏心室致心力衰竭犬房颤模型,研究其电生理及心房结构和功能改变。方法 15只健康杂种犬分两组:对照组6只,实验组9只[240次/min心室起搏(25±3)d]。超声心动图测定起搏前后心房面积、面积缩小分数及左心室功能,利用心内电极测定心房有效不应期、传导速度及房颤诱发情况。结果实验组7只犬完成了实验。快速心室起搏(25±3)d后,犬的收缩末期和舒张末期左、右心房面积显著增大(与起搏前比较,P<0.01),左、右心房面积缩小分数显著减小(左心房:(35.7±1.9)%和(20.7±2.7)%,P<0.01;右心房:(35.0±2.3)%和(18.0±2.3)%,P<0.01),左室射血分数从(65.3±2.1)%降至(31.6±2.8)%(P<0.01)。实验组犬左、右心房有效不应期显著延长,心房内传导速率较对照组减慢。实验组有5只犬诱发出超过30 min的房颤,平均房颤持续时间较对照组显著延长(687±290)s和(13±9)s,P<0.01)。实验组平均房颤持续时间与左、右心房面积及面积缩小分数相关(P<0.05)。结论 快速心室起搏致心衰模型能稳定地诱发出房颤,房颤持续时间与心衰引起的显著心房结构和功能异常相关。     

Atrial natriuretic peptide during acute treatment of congestive heart failure

Summary. Atrial natriuretic peptide (ANP) induces potent diuretic/natriuretic, vasorelaxing and aldosterone inhibitory effects. Increased plasma levels in congestive heart failure (CHF) have been reported. The aim of this study was to investigate plasma immunoreactive ANP (ir-ANP) levels during acute treatment of CHF. Seven patients with CHF underwent cardiac catheterization. Ir-ANP plasma levels were followed up to two h after administration of an orally given phosphodiesterase inhibitor (Milrinone); a substance with positive inotropic and peripheral vasodilating properties. In all patients cardiac output increased and cardiac filling pressures decreased markedly. Initially high ir-ANP plasma levels decreased. Our patients did not have an increased blood volume. It is concluded that plasma ir-ANP levels in the pulmonary artery rapidly decrease when atrial pressure is reduced. These data suggest that atrial pressure is the major determinant for release of ir-ANP in man and that the ability to respond quickly to changes in cardiac filling pressures is maintained in patients with severe CHF. Plasma ir-ANP levels may also become useful as an index of the degree of heart failure and serve as a tool in monitoring response to drug therapy.     

Predictive performance of serum digoxin concentration in patients with congestive heart failure by a hyperbolic model based on creatinine clearance

OBJECTIVES: To formulate a simple equation for determining the daily dose requirements of digoxin by inclusion of creatinine clearance (Ccr) values as an explanatory variable. METHODS: We included 235 routine monitoring and clinical laboratory test data (steady-state serum digoxin concentration and Ccr values), obtained from hospitalized patients receiving digoxin for treatment of congestive heart failure. The 107 data sets were fitted to a hyperbolic model to account for the relation between the ratio of serum digoxin level to the daily dose (L/D) and the Ccr values determined by six methods. Their correlation coefficients (r) were computed by non-linear regression analysis. To evaluate the validity of the best-fitting model, the predictive performance of the L/D ratios was compared with those given by seven reference models previously published, using another 128 data sets. RESULTS: The hyperbolic model involving the Ccr values estimated by Cockcroft and Gault's equation showed the closest correlation (r = 0.81) between the actual and estimated Ccr values. Mean prediction error (ME), a measure of bias, of the L/D ratio (0.018 ng/mL) was almost negligible when other data were fitted to the proposed model, and this ME value proved to be much smaller than those calculated from the previously published prediction models. Mean absolute prediction error, a measure of precision, by the proposed model was also satisfactory for prediction. CONCLUSION: The newly developed model provided good predictive performance of serum digoxin level. Taking simplicity in practical use into account, the clinical application of the proposed model will allow for accurate and rapid determination of the initial maintenance dosing regimen of digoxin based on the individual Ccr value, without actual measurement of its serum concentration.     

正性肌力药物治疗充血性心力衰竭

对正性肌力药物治疗充血性心力衰竭进行综述,其中包括洋地黄类和非强心甙类正性肌力药物,着重分析新近开发的药物,如多巴胺类、磷酸二酯酶抑制剂及钙增敏剂。     

Catheter ablation for atrial fibrillation: a promising therapy for congestive heart failure

Atrial fibrillation (AF) and congestive heart failure (CHF) are cardiovascular epidemics. Catheter ablation of AF is increasingly performed in patients with CHF. Atrioventricular junction ablation (AVJA) and pulmonary vein isolation are the two predominant ablation strategies used to treat AF patients who are refractory to drugs. In patients with CHF refractory to drugs, AVJA with a biventricular device is associated with improvement in exercise capacity and quality of life. However, in a head-to-head comparison, pulmonary vein antrum ablation was shown to be superior to AVJA. Cure of AF in patients with CHF resulted in more significant morphological and functional improvements than AVJA.