用两种剂量福辛普利治疗重症心力衰竭患者的临床研究

目的：比较两种剂量福辛普利治疗重症心力衰竭(HF)的临床疗效、安全性和防治心血管事件的作用。方法：将85例NYH心功能Ⅲ，Ⅳ级重症HF患随机单盲分为2组：福辛普利20mg／d组43例；福辛普利10mg/d组42例，治疗1年，观察患心功能、不良反应和心脏性事件发生情况。结果：福辛普利治疗重症HF3、12个月，2组均能明显改善心功能。包括临床症状改善总有效率，超声心动图左心室射血分数(LVEP)、左心室短轴缩短率(FS)、二尖瓣快速充盈期和心房收缩期二尖瓣血流速度(E／A)，也能降低纤溶系统的纤溶酶原激活物抑制剂—1(PAI—1)、纤维蛋白原(FG)、C—反应蛋白(CRP)、且20mg／d组对上述指标改善均优于10mg／d组，(P＜0．05)，同时20mg／d组治疗3，12个月发生不稳定型心绞痛(UP)，心律失常事件比10mg／d组明显减少(P＜0．05)，而2组治疗后3，12个月血压及心率均较治疗前明显下降(P＜0．05)，但无组间差异(P＜0．05)，2组不良反应轻微。结论：用福辛普利20mg／d治疗重症HF，预防心脏性事件较合适，需否用40mg 1次／d，仍需临床探讨。

Clinical Study on Patients with Severe Heart Failure with Fosinopril in Two Dosages

Objective: To investigate the effects of Fosinopril in two dosages in the treatment of severe heart failure (HF) . The effects include clinical results, safeties, and protective roles on cardiovascular events. Methods: 85 patients with severe heart failure ( NYHA grade HI -,1V) were divided into two groups at random and single - blind. All patients were given Fosinopril (43 cases 20 mg daily and another 42 cases lOmg daily) for 1 year. Patients were observed in heart functions, side effects, and cardiovascular events. Results: In the management of severe heart failure, Fosinopril could ease clinical symptoms and improve heart function in two dosages at the third month and the twelfth month. Fosinopril could increase some indexes of heart function in echocardiography (UCG) and decrease some indexes of fibrinolytic system . These indexes include left ventricular ejection fraction (LVEF), Left ventricular fractional shortening of minor - semin axis(FS) ,the ratio between peak flow velocity of early diastole and atrial contraction(E/A), plasinogen activator inhibitor 1 (PAI - 1), fibrinogen(FG), and c reaction protein (CRP) . The changes of these indexes in the group that patients were given Fosinopril 20 mg daily were more than these in another group (all P < 0.05). The decreases of attacks of unstable angina pectoris (UP) and arrhythmia events in the former were more than these in the later (all P < 0.05). There were clear decreases of blood pressure and heart rate in two groups at the third month and the twelfth month ( all P < 0.05), but there were not differences in two groups (all P > 0.05). The side effects were slight. Conclusion: It was suitable to treat heart failure and prevent cardiovascular events with Fosinopril. It should be studied on Fosinopril 40 mg daily.