卡维地洛和美托洛尔对左室舒张功能及心室重塑影响的对比观察

目的探讨卡维地洛与美托洛尔两种不同类型的β-受体阻滞剂对充血性心力衰竭患者左室舒张功能和心室重塑的影响。方法将68例充血性心力衰竭患者在常规治疗心力衰竭(心衰)基础上随机分为卡维地洛组(A组35例)和美托洛尔组(B组33例),应用超声心动图分别于治疗前、治疗6个月后、12个月后测量左心室舒张早期充盈峰速度(E峰)、左心室舒张晚期充盈峰速度(A峰)、E/A、左心室舒张早期充盈峰减速时间(EDT)、E波流速积分(Ei)以及室间隔厚度(IVS)、左室后壁厚度(IVPW)、左室重量指数(LVMI)、左室球径指数(LVGI)。结果随访59例(A组30例、B组29例)发现:①治疗6个月时,两组的E峰、A峰、E/A、LVMI、LVGI均较治疗前差异有高度显著性(P<0.01);A组LV-MI、LVGI较B组显著减少(P<0.05或0.01)。②治疗12个月时两组的E峰、A峰、E/A、LVMI、LVGI、IVS、LVPW均较治疗前明显改善(P<0.01或0.05);A组的E峰、LVMI、LVGI、LVPW较B组差异有显著性(P<0.01或0.05)。结论卡维地洛在改善左心室舒张功能和心室重塑方面较美托洛尔更显著,治疗充血性心力衰竭更有优势。

A comparison of the influences on left ventricular diastolic function and ventricular remodeling between carvedilol vs. metoprolol

Objective To investigate the influences of two different β-blockades(carvedilol and metoprolol) on left ventricular diastolic function and ventricular remodeling in patients with congestive heart failure(CHF).Methods 68 patients enrolled in this study received the same conventional treatment of heart failure,and then were randomly divided into a carvedilol group(group A,n=35) and a metoprolol group(group B,n=33).Before treatment and on month 6 and month 12 after treatment,an echocardiogram was used to detect the E peak,A peak,E/A,EDT,Ei,IVS,IVPW,LVMI and LVGI.Results A follow-up for 59 cases(30 cases in group A and 29 cases in group B) found: ① On month 6 after treatment,the levels of E peak,A peak,E/A,LVMI and LVGI in groups A and B were higher comparing to those before treatment,there were statistically significant differences(P<0.01).In comparison to group B,LVMI and LVGI decreased significantly(P<0.05 or 0.01).② On month 12 after treatment,the levels of E peak,A peak,E/A,LVMI,LVGI,IVS,LVPW in groups A and B got better results than treatment before(P<0.01 or 0.05).In group A,the levels of E peak,LVMI,LVGI,LVPW got more relief than group B(P<0.01 or 0.05).Conclusion Carvedilol can get a better result in ameliorating the left ventricular diastolic function and ventricular remodeling than metoprolol,it can be the first choice for treating CHF.