老年人充血性心力衰竭短期加用小剂量甲状腺素治疗的临床观察

目的　探讨小剂量甲状腺素在老年充血性心力衰竭 (CHF)中的临床疗效。方法　选择 15 6例CHF病人 ,测定血清甲状腺素及超声心动图 (EF ,CO ,PWtf)后分成治疗组和对照组。治疗组在常规治疗基础上加用左旋甲状腺素(L T4) 2 5～ 5 0 μg/d ;对照组仅给常规治疗于病人住院 7d、14d通过评价心功能 ,进行疗效评价。结果　两组病人T3 降低、rT3 明显升高 ,T4、hTSH正常。第 7d ,治疗组有效率较对照组提高 ,但两组比较无统计学意义 (P >0 0 5 ) ;第 14d ,治疗组总有效率 76 19% ,明显高于对照组 (5 8 33% ) (P <0 0 5 ) ;EF、CO、PWtf治疗组均优于对照组 (P <0 0 5 )。结论　对老年重度心力衰竭病人在应用利尿剂、血管紧张素转换酶抑制剂的基础上 ,加用小剂量L T4,对部分老年重症CHF的治疗可能有一定的短期、辅助意义。

Treatment of low dose L-thyroxin in the elderly with congestive heart faiure

Objectives To observe the clinical effects of treatment with low-dose L-thyroxin in the aged patients with congestive heart failure (CHF). Methods A total of 156 aged hospitalizing patients with CHF were randomly divided into two parts, the normal control group were given general treatment, and the treatment group were assigned to be administered low dose L-thyroxin. All patients' plasma level of T 3? T 4? rT 3, hTSH were measured. Echocardiogram was found to evalute EF, CO, PWtf. After the treatment of 7 days and 14 days, every patient's heart function was revalued and the clinical effect was studied. Results All patient plasma level T 3 lowered but plasma level rT 3 obviously higher and plasma level T 4, hTSH had no change before treatment. After treatment of 7 days, clinical effective rate in the treatment group was higher than that in the normal control group, but there was no statistic difference (P<0.05); while after treatment of 14 days, that was 76.19% (P<0.05); and echocardiogram was found EF, CO, PWtf in the treatment group were suprior to that in the normal control group (P<0.05). Conclusions Administration of low dose L-thyroxin might be short-time help to the aged critical patients with CHF. Based on the general treatment with diureties, angiotensin converting enzyme inhibitor (ACEI) , in some aged critical patients with CHF, added to the administration of low-dose L-thyroxin, may short-time help to speed recovery of heart function.