ARB与ACEI联合治疗血液透析患者慢性心力衰竭疗效观察

目的观察联合应用血管紧张素Ⅱ受体抑制剂(ARB)与血管紧张素转化酶抑制剂(ACEI)和单用ACEI治疗血液透析患者慢性心力衰竭(简称慢性心衰)的疗效比较。方法 42例临床确诊为慢性心力衰竭的血液透析患者分为两组,A组单用ACEI治疗20例,B组联合应用ARB与ACEI治疗22例。结果治疗6个月后A组左室射血分数(LVEF)、心脏指数(CI)、心血管病事件发生率及心血管病死亡率分别为49.20±3.27、(4.11±0.35)mL/m2、45%、5%;B组分别为53.36±4.27、(4.43±0.52)mL/m2、22.7%、4.5%。治疗1年后A组LVEF、CI、心血管病事件发生率、心血管病死亡率分别为54.20±2.84、(4.36±0.33)mL/m2、30%、10%;B组分别为61.68±3.50、(5.19±0.30)mL/m2、13.6%、4.5%。结论联合应用ARB与ACEI治疗血液透析患者慢性心衰,在改善心功能疗效方面更优于单用ACEI组,虽然在心血管病事件及心血管病死亡方面比对照组呈现较好的下降趋势,但两组差异无统计学意义。可能需要延长观察时间以判断心血管的长期预后。

Curative effect of therapeutic alliance of ARB and ACEI for hemodialysis patients with chronic heart failure

Objective To observe the effect of angiotensin Ⅱ receptor inhibitors （ARB） combined with angiotensin con- verting enzyme inhibitors （ACEI） in hemodialysis patients with chronic heart failure. Methods A total of 42 Hemodialysis pa tients with chronic heart failure （LVEF〈40%） divided into two groups： group A of 20 patients with ACEI treatment, group B of 22 patients with ARB combined with ACEI. Results After 6 months, LVEF, CI, cardiovascular events rate and cardio- vascular death rate was 49.20±3.27, （4.11±0.35） mL/m2, 45%, 5% in group A and 53.36±4.27, （4.43±0.52） mL/ m2, 22.7%, 4.5% in group B, respectively. One years later, LVEF, CI, cardiovascular events rate, and cardiovascular death rate was 54. 20±2. 84, （4.36±0.33） mL/m2, 30%, 10% in group A and 61.68±3.50, （95. 19±0.30） mL/m2, 13.6%, 4.5% in group B, respectively. Conclusion Therapeutic alliance of ARB and ACEI for hemodialysis patients with chronic heart failure was better in improving heart function than ACEI groups. Though the cardiovascular events rate and cardi- ovascular death rate were better in group B than those in group A, but the difference was not statistically significant. It may need to extend the observation time to determine the long-term outcomes of cardiovascular.