卡维地洛治疗扩张型心肌病心力衰竭疗效观察

目的　评价第三代 β受体阻滞剂卡维地洛治疗扩张型心肌病 (DCM)心力衰竭的临床疗效。方法　 6 2例 DCM心力衰竭患者在接受常规治疗 (洋地黄、利尿剂、血管紧张素转换酶抑制剂 )病情稳定后 ,随机分为卡维地洛组和美多心安组。均从小剂量 (卡维地洛组 ,2 .5 m g bid;美多心安组 ,6 .2 5 m g bid)缓慢递增。检测治疗前后 DCM患者左心室功能和结构的变化以及血液中内皮素 - 1(ET- 1)、心钠素 (ANP)和血管紧张素 (Ang )的改变。结果　治疗 6个月后 ,两组心脏功能分级均明显改善 ,左心室射血分数 (L VEF)、短轴缩短率 (FS)、左心室射血前期与射血时间比(PEP/ L VET)、舒张早期峰值血流速度 (PFVE)、舒张早期峰值血流速度与舒张晚期峰值血流速度比 (PFVE/ PF-VA)均明显增加 ,卡维地洛组较美多心安组 L VEF增加更为明显。两组左心房内径 (L AD)、左心室收缩末期内径(L VSD)、左心室舒张末期内径 (L VDD)明显减小 ,卡维地洛组 L VSD减小较美多心安组更明显。治疗后血浆中ET- 1、ANP和 Ang 均明显降低。结论　卡维地洛和美多心安都能够改善 DCM心力衰竭患者左心室收缩和舒张功能 ,逆转左心室重构 ,卡维地洛较美多心安疗效更佳。

Effects of carvedilol on congestive heart failure in patients with dilated cardiomyopathy

Objective To evaluate the clinical therapeutic effects of the third generation β-blocker carvedilol on congestive heart failure in the patients with dilated cardiomyopathy(DCM) Methods 62 patients with cardiac heart fai- lure secondary to DCM were treated with digitalis, duretics or ACEI and divided randomly into carvedilol group and metoprolol group. Both groups were given small does in the beginning. The function and structure of left ventricule and the plasma endothelin-1 (ET-1), atrial natriuretic peptide(ANP), angiotension Ⅱ(Ang Ⅱ) were measured before and after six months treatment. Results Six month after treatment, NYHA class was improved in both groups, Fractional shortening (FS), pre-ejection period/left ventricule ejection time (PEP/LVET), peak flow velocity of early diastole (PFVE) and PFVE/ peak flow velocity of atrial contraction (PFVA) were augmen- ted too. Left ventricular ejection fraction (LVEF) was increased, which was more significant in carvedilol group than that in metroprolol group. Left atrial dimension(LAD),left ventricular systolic dimension (LVSD), left ventricular diastolic dimension(LVDD) and the level of ET-1, ANP, AngⅡ in plasma were decreased significantly after treatment. Conclusion Carvedilol and metoprolol can improve left ventricular function and prevent left ventricular remolding in DCM patients with congestive heart failure. Carvedilol is more effective than metoprolol in some aspects.