卡维地洛对缺血性心脏病心力衰竭患者心室重塑和心功能的影响

目的　探讨卡维地洛对缺血性心脏病心力衰竭患者心室重塑及心功能的影响。方法　将缺血性心脏病心力衰竭患者 77例 [左室射血分数≤ 45 % ,心功能 (NYHA)Ⅱ～Ⅳ级 ]随机分为治疗组 (常规药疗加卡维他洛 )和对照组 (常规药疗 )。治疗组加用卡维地洛 ,卡维地洛平均用量 (2 4.6± 11.3mg/d)。治疗 6个月。应用心脏彩色超声仪测定治疗前后左室结构及心功能指标变化。结果　经过 6个月的治疗 ,卡维地洛治疗组症状和心功能改善与对照组比较 :左室射血分数上升 [(4 8.5± 2 .4) %VS(3 8.9± 2 .61) % ,P =0 .0 0 2 ]、左室收缩末容积下降 [(163 .70± 45 .3 0 )mlVS(181.5 0± 43 .80 )ml,P =0 .0 43 ] ;与治疗组 (按NYHA分为Ⅱ、Ⅲ、Ⅳ级三组 )治疗前比较 :左室舒张末容积下降 (P <0 .0 5 ) ;但两两组间差异无显著性。结论　在强心、利尿、血管紧张素转化酶抑制剂治疗的基础上 ,应用卡维地洛能显著改善缺血性心脏病心力衰竭患者的心功能 ,改善心室重塑。

The effects of Carvedilol therapy on the left ventricular remodeling and function in the patients of ischemic heart disease with cardiac dysfunction

Objective To investigate the cardiac function improvement and ventricular remodeling with Carvedilol therapy in the patients of ischemic heart disease with heart failure. Methods 77 patients of ischemic heart disease with heart failure, i.e, ventricular ejection fraction (VEF) ≤45%, cardiac function (NYHA) Class Ⅱ～Ⅳ, were divided into the therapeutic group (received traditional therapy plus Carvedil) and the control group (received traditional therapy). After 6-month treatment, the color heart ultrasonograph was used to measure the ventricular structure and the changes of cardiac function indexes before and after treatment. Results The mean dose of Carvedilol was (24.6±11.3mg/d). After 6-month treatment, in comparison to the control group, the symptom and cardiac function improved in the therapeutic group: VEF increased [(48.5±2.4)% VS (38.9±2.61)%, P=0.02], left ventricular end-systolic volume (LVESV) decreased [(163.70±45.30)ml VS (181.50±43.80)ml, P=0.043]. In the therapeutic group (subdivided into Group Ⅱ,Ⅲ and Ⅳ, according to NYHA), comparing to pre-treatment: LVESV decreased (P<0.05); but there was no statistically significant difference between groups. Conclusions Based on the medication of oral digitalis, diuretics and angiotension-converting enzyme inhibitors, carvedilol therapy can improve left ventricular performance, reverse LV remodeling in patients of coronary heart disease with heart failure and also improve the biological properties of the chronically failing heart.