托拉塞米联合美托洛尔治疗慢性充血性心力衰竭的临床研究

目的 探讨托拉塞米联合美托洛尔治疗慢性充血性心力衰竭的临床疗效。方法 选取2017年1月－2018年12月在延安大学附属医院接受住院治疗的116例慢性充血性心力衰竭患者为研究对象。对照组患者口服酒石酸美托洛尔片，起初6.25 mg/次，2~3次/d，以后视临床情况每数日至1周增加6.25~12.5 mg，2~3次/d，最大剂量可用至50~100 mg/次，2次/d；观察组在对照组基础上加用托拉塞米片，起初剂量为10 mg/次，1次/d，以后视临床情况可将剂量增至20 mg/次，1次/d，最大剂量可用至每日40 mg。两组患者均连续治疗7 d。观察两组患者的临床疗效，同时比较两组患者治疗前后的二尖瓣舒张早期与舒张晚期血流峰值速度比值（E/A）、左室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、血钠、血钾、血肌酐（Scr）、血清嗜铬粒蛋白A（CgA）及半乳糖凝集素-3（galectin-3）水平。结果 治疗后，观察组患者总有效率为87.9%，明显高于对照组的70.7%（P<0.05）。治疗后，两组患者LVEDD、LVESD均显著降低（P<0.05），与对照组比较，观察组下降程度更明显（P<0.05）；两组患者E/A、LVEF均显著上升（P<0.05），与对照组比较，观察组上升程度更明显（P<0.05）。治疗后，两组24 h尿量显著增多（P<0.05），并且观察组24 h尿量显著多于对照组（P<0.05）；治疗后，两组患者血钠、血钾、Scr的比较差异均无统计学意义。治疗后，两组患者血清CgA及galectin-3水平显著降低（P<0.05），且观察组明显低于对照组（P<0.05）。结论 托拉塞米联合美托洛尔治疗慢性充血性心力衰竭疗效较好，有利于缓解临床症状，改善心功能，降低血清CgA和galectin-3的水平，抑制心肌纤维化进程，明显改善心室重构，提高治疗效果。

Clinical study of torasemide combined with metoprolol in treatment of chronic congestive heart failure

Objective To analyze the clinical effcacy of torasemide combined with metoprolol in treatment of chronic congestive heart failure. Methods A total of 116 chronic congestive heart failure patients hospitalized in the Yan''an University Affiliated Hospital from January 2017 to December 2018 were selected as study subjects. Patients in the control group were po administered with Metoprolol Tartrate Tablets, 6.25 mg/time, 2-3 times daily, and then increased 6.25-12.5 mg, 2-3 times daily, depending on the clinical situation every days to a week. The maximum dose could be up to 50-100 mg/time, twice daily. Patients in the observation group were po administered with Torasemide Tablets on the basis of the control group, the initial dose was 10 mg/time, once daily, and the dose could be increased to 20 mg/time, once daily depending on the clinical situation. The maximum dose could be up to 40 mg per day. Both groups received continuous treatment for 7 days. After treatment, the clinical efficacy of two groups were compared, and the levels of E/A, LVEF, LVEDD, LVESD, serum sodium, potassium, Scr, CgA, and galectin-3 before and after treatment were compared. Results After treatment, the total effective rate in the observation group was 87.9%, which was significantly higher than 70.7% in the control group (P<0.05). After treatment, LVEDD and LVESD in both groups were significantly reduced (P<0.05). Compared with the control group, the degree of reduction in the observation group was more significant (P<0.05). E/A and LVEF were significantly increased in both groups (P<0.05), and the increase was more significant in the observation group than in the control group (P<0.05). After treatment, urine output in two groups increased significantly at 24 h (P<0.05), and the observation group was significantly higher than the control group (P<0.05). After treatment, there were no statistically significant differences in serum sodium, serum potassium and Scr between two groups. After treatment, serum CgA and galectin-3 levels in two groups were significantly decreased (P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusion Torasemide combined with metoprolol has a good therapeutic effect on chronic congestive heart failure, which is beneficial to the alleviation of clinical symptoms, improvement of cardiac function, reduction of serum CgA and galectin-3 levels, inhibition of myocardial fibrosis process, significant improvement of ventricular remodeling, and improvement of therapeutic effect.