卡维地洛治疗慢性心力衰竭的临床疗效观察

目的研究卡维地洛治疗慢性心力衰竭(CHF)患者的临床疗效及耐受性,为临床合理用药提供依据。方法108例CHF患者随机分为卡维地洛组、美托洛尔组及对照组,每组36例,所有患者治疗心力衰竭基础药物(洋地黄、利尿剂、血管紧张素转换酶抑制剂)不变,而卡维地洛组、美托洛尔组分别加用卡维地洛及美托洛尔。于治疗前及连续治疗6月后进行心功能(NY-HA)分级评估,测量心率、血压及心电图、超声心动图检测,观察LVEDD、LVESD及LVEF变化。结果2例因用药后病情恶化而退出,106例完成全程治疗及随访,结果显示,与治疗前比较,卡维地洛组及美托洛尔组均可显著改善心功能分级、LVEF,并降低血压及心率,(分别为P<0.05、P<0.01)。而对照组患者治疗前后心功能分级、LVEF、血压及心率的变化均无显著差异。卡维地洛组3例发生低血压,美托洛尔组发生低血压及心动过缓各1例,无死亡患者。对照组再次入院人数(17例)较卡维地洛组(2例)及美托洛尔组(4例)明显增加(P<0.01)。结论在心力衰竭常规药物基础上加用卡维地洛,可以明显改善心功能,降低再次入院率。

Clinical observation of therapeutic effect of carvedilol treating chronic heart failure

Objective To investigate the clinical effect and safety of carvedilol in patients with chronic heart failure(CHF),so as to provide basis for rational administration in clinic.Methods 108 CHF patients were randomly divided into carvedilol group(n=36),metoprolol group(n=36)and negative control group(n=36).Besides general treatments,carvedilol group and metoprolol group were respectively treated with carvedilol and metoprolol.Before and after the 6 months' continuous treatments,NYHA grading assessment of cardiac function was performed,while heart rate,blood pressure,electrocardiogram,ultrasonic cardiogram were all measured to display the changes of left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD)and left ventricular ejection fraction(LVEF).Results Two patients were excluded in the clinical research because of their deteriorated condition,and 106 patients completed the whole course treatment and follow-up visit.Compared with pathogenetic condition of pretherapy,the cardiac functional grading and LVEF were improved,while blood pressure and heart rate decreased in both carvedilol group and metoprolol group.In contrast,there were no significant differences of the above parameters between pre-and post-therapy in control group.Three cases in carvedilol group presented hypotension.One patient in metoprolol group presented low blood pressure,and one presented bradycardia.No patients ended with death.The number of readm in control group was significantly higher than that of carvedilol group as well as metoprolol group(P<0.01).Conclusion On basis of conventional therapy,carvedilol can improve heart function and decrease the readm rate.