小剂量螺内酯治疗冠心病慢性心力衰竭的疗效及安全性分析

目的探讨小剂量螺内酯治疗冠心病慢性心力衰竭的疗效及安全性分析。方法冠心病慢性心力衰竭患者90例按随机数字表法分为两组，每组各45例。小剂量组加用螺内酯20mg／d，中剂量组加用螺内酯40mg／d。疗程12周。比较两组心功能指标及不良反应，并评价疗效。结果小剂量组总有效率为93．33％（42／45），中剂量组为95．56％（43／45），差异有统计学意义（p>0.05）。两组LVMI、LVDd、E/A、LVEF均较治疗前显著改善（t=4．31、4．92、4．11、4．62、6．34、5．78、5．56和5．92，P〈0．05）：两组比较，上述指标均无显著差异（t=1．13、0．90、1．10和2．01，P〉0．05）。中剂量组出现3例高血钾．3例乳腺增生，两组不良反应比较，差异有统计学意义（P〈0．05）。结论小剂量螺内酯治疗冠心病慢性心力衰竭可逆转心室重构，改善心功能．安全性更优，值得临床推广应用。

Analysis on the Efficacy and Safety of Small Dosage of Spironolactone in Treating Coronary Heart Disease and Chronic Heart Failure

OBJECTIVE To evaluate the efficacy and safety of small dosage of spironolactone in treating coronary heart disease and chronic heart failure. METHODS 90 cases of coronary heart disease in patients with chronic heart failure were randomly divided into two groups, 45 patients in each group. Low dose group were treated with spironolactone 20mg/d, middle dose group and spironolactone 40mg/d, treatment for 12 weeks. Comparison of two groups of indexes of heart function and adverse reactions, and evaluate the effect. RESULTS The small dose group＇s the total effective rate was 93.33%（42/45）, middle dose group was 95.56%（43/45）, the difference was statistically significant（~：=0.32, P〉0.05）. Two groups of LVMI, LVDd, E/A, LVEF than before treatment significantly improved （t=4.31, 4.92, 4.11, 4.62, 6.34, 5.78, 5.56 and 5.92, P〈0.05）; the two groups had no significant difference, the above indexes （t=l.13, 0.90, 1.10 and 2.01, P〉0.05）. 3 cases of hyperkalemia appears in middle dose group, 3 cases of breast hyperplasia, adverse reactions of two groups, the difference was statistically significant （P〈0.05）. CONCLUSIONS Low dose of spironolactone in the treatment of chronic heart failure of coronary heart disease could reverse left ventricular remodeling, improved the heart function, safety was better, was worthy of clinical application.