应用大剂量依普利与卡维地络联合治疗女性心肌炎后心肌重塑安全性及疗效观察

目的评价大剂量依那普利与卡维地络联合治疗在心肌炎后心肌重塑患者中应用的安全性及疗效。方法63例女性心肌炎后心肌重塑患者,平均年龄17.56岁(13~28岁),心功能Ⅱ-Ⅳ级,左室射血分数(36.28±9.26)%,从小剂量开始使用,只要能够耐受尽可能递增到卡维地络20mg/d,依那普利20mg/d,血压达到最低耐受程度100~90/60~50mmHg,治疗中严密监测各项相关指标。结果平均治疗6周,治疗后心功能和6min步行距离较前明显改善〔(2.04±0.66)m比(3.5±0.65)m,(310.29±180.14)m比(200.87±175.97)m,P<0.001〕,超声心动图检查左室舒张末径(LVEDD)和收缩末径(LVESD)减少〔(60.38±9.12)mm比(55.03±9.80)mm和(48.37±10.27)mm比(43.17±11.03)mm,P<0.001〕;LVEF明显增加〔(36.28±9.26)%比(45.37±6.14)%,P<0.001〕;二尖瓣关闭不全85%达到完全关闭,15%的患者二尖瓣关闭明显改善,返流面积由(3.16±0.23)cm2减少至(0.65±0.36)cm2。三尖瓣关闭不全88%达到关闭,未关闭患者三尖瓣返流面积由(1.98±0.02)cm2减少至(0.3±0.01)cm2。结论大剂量应用依那普利和卡维地络联合治疗心肌炎后心肌重塑是安全的、有效的。能明显提高心肌炎患者活动耐量,使绝大部分患二尖瓣、三尖瓣关闭不全的患者完全关闭,改善心功能,增加LVEF。

Study of the effect and safety that a large dose of enapril combined with carvedilol on treating females cardiac remodeling after cardiomyopathy

Objective:To evaluate the effect and safety that a large dose of enapril combined with carvedilol on treating cardiac remodeling after cardiomyopathy.Methods:63 female cases that cardiac remodeling after cardiomyopathy average 17.56 years (13~28 years), heart function Ⅱ-Ⅳclass, left ventricular ejection fraction (LVEF) (36.28±9.26)%, at the beginning low dose and then slowing increased to carvedilol 20 mg/d enalpril 20 mg/d as to the dose can be just tolerated. The blood pressure reached to the lowest tolerance 100~90/60~50 mmHg. All index during the treatment were monitored.Results:Average 6 weeks treatment, the heart function and walk testing of 6 min were obviously improved (2.04±0.66) mm to (3.5±0.65), (310.29±180.14) to (200.87±175.97) m (P<0.001), echocardiogram examination of LVEDD and LVESD all decreased (60.38±9.12) mm to (55.03±9.80) mm and (48.37±10.27) mm to (43.17±11.03) mm (P<0.001)·LVEF obviousely increased (36.28±9.26)% to (45.37±6.14)% (P<0.001);85% mitral valve insufficiency can completely shut,15% patients who mitral valve insufficiency be ameliorated. The backstreaming area decreased from (3.16±0.23)cm to (0.65±0.36)cm; 88% patients who tricuspid cannot shut and the backstreaming area decrease from (1.98±0.02) cm2 to (0.3±0.01) cm2.Conclusion:It is safety and effect to use a large dose of enapril combined with carvedilol on treating cardiac remodeling after cardiomyopathy.It obviously improves the activity tolerance of the cardiomyopathy patients and makes a lot of patients who suffering mitral or tricuspid valve insufficiency completely shut and improve the heart function and increase the LVEF.