咪哒普利治疗慢性心力衰竭的临床疗效及安全性观察

目的比较咪哒普利和螺内酯治疗重度心力衰竭(CHF)的疗效和安全性。方法将病人随机分为A、B两组,两组年龄、性别、病因及基础用药具有可比性,所有患者均在进行CHF常规治疗的基础上。A组口服咪哒普利从2.5mg每天1次开始,一周后加至5mg每天1次;B组口服螺内酯20mg,每天1次,维持至6个月。治疗前、后对比心功能分级、实验室检查、心电图及超声心动图检查。测定左房内径(LA),左室收缩末期内径(LVS)、左室舒张末期内径(LVD)、左室舒张末期容量(WEDV)、左室收缩末期容量(LVESV)、室间隔厚度(IVS)、左室后壁厚度(WP)、左室射血分数(LVEF)和短轴缩短率(D)。运动耐量检测用6min步行试验。服药期间密切观察不良反应,每两周记录1次。结果两组治疗前后6个月的超声指标均有明显改善,心率、血压明显下降,6min步行试验均有明显提高,而A组较B组更为显著。两组实验室检查差异无统计学意义。结论咪哒普利与螺内酯对慢性心力衰竭患者均有较好的疗效。在运动耐量改善方面,咪哒普利更为明显,是慢性心力衰竭治疗中的又一有效措施。

The effect and safety of Imidapril in curing severe heart failure

Objective Compare the effect and safety of Imidapril in curing severe heart failure with that of Spironolactone. Methods The patients were randomly divided into team A and B. It has significant statistic meaning among age, sex, pathogeny and basic medicine treatment between the two teams. Besides routine congestive heart failure (CHF) treatment, each patient in team A was given a dose of Imidapril, 2.5mg QD Po. at start. One week later, the dose was added to 5mg QD, the patients of team B were individually given a dose of Spironolactone, 20mg QD Po. , After six months treatment, we compare the class of cardiac function, with that of six months ago. We measured the patients' left atrium bore (LA), left ventricular systolic (LVS), left ventricular end-diastolic bore (LVD), left ventricular end-diastolic volume (LEDV), left ventricular end-systolic volume (LVESV), inter-ventricular septum (IVS), wide of left ventricular posterior wall (WP), left ventricular ejection fraction (LVEF) and shortening rate of short axis (D) by the laboratory examination, electrocardiogram and echocardiography. We used six-min-step walking examination to detect the patients' exercise tolerances. During the period of administration, the side effect has been closely remarked once two weeks. Results It was obvious of the improvement in ultrasonic index (Table 1) of the two teams, as well as the descent of the heart rate and blood pressure (Table 2) after six months' administration; there has no significant difference in laboratory examination between the two teams. Conclusion Imidapril and Spironolactone have satisfying effect in chronic heart failure (CHF). Imidapril is much better on the respect of the improvement of exercise tolerance; it is valid in curing CHF.