螺内酯和美托洛尔对老年慢性心力衰竭左室重构的影响

目的探讨螺内酯和关托洛尔联合应用对老年慢性心力衰竭患者左室重构的影响。方法老年慢性心力衰竭患者60例，心功能（NYHA）分级Ⅲ～Ⅳ级者；左心室射血分数（LVEF）≤0．45，分为3组。A组20例常规治疗（利尿、扩血管及强心等药物）加用螺内酯与关托洛尔，B组20例在常规治疗加美托洛尔，C组20例常规治疗加用螺内酯。3个月后超声心动图测量左室收缩末容积（LVESV），左室舒张末容积（LVEDV），射血分数（LVEF），评价左室容积和左心功能。结果A组LVESV、LVEDV明显降低，LVEF增加，与B、c组相比有显著差异（P〈0．05）。A组、B组、C组治疗后与治疗前比较，LVESV、LVEDV降低，LVEF增加（P〈0．05）。治疗后B组与C组相比无显著差异（P〉0．05）。结论老年慢性心力衰竭患者Ⅲ-Ⅳ级在常规治疗基础上联合应用螺内酯和美托洛尔，可更好地抑制左室重构，防止左室扩张，抑制心衰的发生。

The effect of Spironolactone and Metoprolol on left ventricular remodeling

Objective To observe the effect of aldosterone antagonist - Spironolactone and Metoprolol on left ventricular remodeling. Methods A total of sixty elderly patients with chronic heart failure in the department of cardiovasology of this hospital were selected for this study. The diagnosis was based on Framingham （American） criteria, and heart failure was graded by NYHA. Among them, 20 patients were randomly allocated into conventional treatment group （ group A） with Metoprolol and Spironolactone besides routine treatment. Twenty patients in group B were treated with Metoprolol besides routine treatment. The remaining 20 patients allocated into group C were treated with Spironolactone besides routine treatment. The treatment was continued on till the end of 12th week. The LVEDV, LVESV and LVEF were measured by VIVID FIVE echocardiograms at 1 st day and the end of 12 th week of treatment. Results The results were indicated by mean ＋ standard deviation. T test was used to compare the difference of parameters among three groups and the analysis of variance was applied to compare the difference among groups. P 〈 0. 05 indicated that there is significant difference among groups. The results in this study are showed as follows ： changes of LVEDV, LVESV and LVEF in pre - treatment and post - treatment. LVEDV and LVESV were obviously decreased and LVEF was increased when compared with those of 1 st day in patients with heart failure after routine treatment. LVEDV, LVESV and LVEF were obviously improved in patients of group A （ Spironolactone and Metoprolol group ） when compared with those of group B and group C. Conclusion Patients in Spironolactone and Metoprolol group can effectively resist left ventricular remodeling when compared with that of patients in groups B and C. Spironolactone and Metoprolol can improve the long - term prognosis and reduce death rate, and they will give advantages to patients with heart failure for a long time when compared with traditional treatment of correcting abnormal hem