小剂量甲状腺激素治疗老年严重慢性心力衰竭的临床研究

目的探讨在常规治疗的基础上加用小剂量甲状腺素治疗老年人冠心病严重心力衰竭（CHF）患者的临床疗效。方法CHF患者76例随机分为治疗组与对照组，治疗组在常规治疗的基础上给予口服甲状腺片5～20mg，1次／d，共14d。对照组不用甲状腺片。比较两组治疗14d后心功能NYHA分级、6min步行距离、心脏超声心动图测量的左室射血分数（LVEF）、左室舒张末容积（LVEDV）、左室收缩容积（LVESV）、心输出量（CO）和心电图的改变情况。结果治疗14d后治疗组与对照组比较：①心功能NYHA分级（2．6±0．5比2．84±0．5，P=0．0378），6min步行距离[（2674±48）m比（2234-55）m，P=0．0321]，LVEF[（35．14±8．0）％比（31．84±9．0）％，P=0．0127]，LVEDV[（172．94±60．6）ml比（186．6±91．7）ml，P=0．0489]，LVESV[（121．24±48．5）ml比（133．34±68．6）ml，P=0．0132]，CO[（4．56±1．32）L／min比（4．44±1．26）L／min，P=0．0102]，均为P〈0．05，差异有统计学意义。②ECG恶性心律失常发生率、死亡率：治疗组2例，对照组3例，差异无统计学意义（P〉0．05）。治疗期间治疗组未发现甲状腺功能亢进表现。结论在常规治疗的基础上加用小剂量甲状腺素治疗老年人冠心病严重CHF，可显著提高疗效，治疗期间且未发现甲状腺功能亢进表现。

Clinical study on the therapeutic effect of thyroxin in small dose to chronic heart failure of old people

Objective To investigate the clinical effect of thyroxin in small close on chronic heart failure of old people. Methods 76 cases of CHF were divided into two groups randomly. The treatment group were treated by thyroxin in addition to routine treatment, and the contrast group were treated by routine treatment. The changes of cardiac function, Six-minuts step ,LVEF, LVEDV, LVESV,CO and ECG of the two groups were compared. Results Compare the two groups after fourteen day＇s treatment： （l）Cardiac function （NYHA level）： （2.6±0.5 vs 2.8±0.5,P=0.0378）,six-minuts step[（267-±48）m vs （223±55）m,P=0.0321],LVEF[（35.1±8.0）% vs （31.8±9.0）% ,P=0.0127] ,LVEDV[ （ 172.9±60.6）ml vs （ 186.6_±91.7）ml,P=0.0489 ], LVESV [ （ 121.2±48.5）ml vs （ 133.3±68.6 ）ml, P=0.0132 ], CO [ （4.56± 1.32 ）L/min vs （4.44± 1.26 ）L/min, P=0.0102 ], P〈0.05. The deviation is explained,statistical significance. （2）Incidence rate of bad arrhythmia in ECG and mortality in the two groups：2 case of treatment group and ：2 case of contrast group（P〉0.05）. The deviation is unexplained. And thyrotoxicosis is not found in the treatment group. Condusion It is effective and feasible to treat severe CHF of old people using small dose thyroxin in addition to routine treatment. Thyrotoxicosis is not observed in the treatment group.