依那普利联合比索洛尔治疗慢性心力衰竭的临床观察

Therapeutic Effects of Enalaril Plus Bisoprolol on Chronic Congestive Heart Failure

目的:观察血管紧张素转换酶抑制剂依那普利和β-受体阻滞剂(比索洛尔)联合应用对慢性心力衰竭(CHF)的远期疗效.方法:共选择CHF患者98例,随机分为治疗组(50例)和对照组(48例).对照组采用常规治疗(即强心、利尿、扩血管);治疗组在此基础上加用依那普利(5～20)mg/d和比索洛尔(3.75～10)mg/d.依那普利初始剂量为2.50 mg,每日一次;比索洛尔初始剂量为1.25 mg,每日一次,逐渐加量至患者所能忍受的最大剂量并长期维持治疗至试验结束,随访时间为一年.在治疗前和观察满一年分别做超声心动图检查测定左室射血分数(EF)和左室缩短分数(FS)及6min步行试验并记录步行距离.结果:一年后,对照组和治疗组因心力衰竭加重再住院率分别为47.9%和22.9%(P＜0.05),病死率分别为18.8%和4.2%(P＜0.05);与治疗前比较,治疗组心功能(EF和FS)及6min步行距离有明显改善(P＜0.01),而对照组改善不明显.结论:依那普利联合比索洛尔可显著改善CHF患者的远期预后.

Objective: To observe the long term effect of angiotensin converting enzyme inhibition (ACEI, enalapril) and β-blocker(bisoprolol).Combination in the treatment of congestive heart failure(CHF).Methods:98 patients with CHF were divided randomly into two groups, the test group (n=50) in which enalapri(415～20)mg/d plus bisoprolo(3.75～10)mg/d based on the routine treatment and the control group (n=48) in which the routine treatment was given. The investigators must ensure that the patients had reached the tolerant dose of enalaril plus bisoprolol and maintained to the end of the test. The FS and left ventricular ejection fraction (LVEF) on echocardiogram were compared between before test and after 1 year test. Results: The hospitalization rate caused by recurrent CHF in the test and control group was22.9% and 47.9% respectively(P<0.05);the mortality rate in the control and test groups was 18.8% and 4.2% respectively (P<0.05).The LVEF in the control group had little changes, while it was increased to(46.75±11.58)%from(36.47±10.82)%(P<0.01),and the distance of 6 min walking test increased substantially from (318.3±16.27)m to (369.7±16.35)m(P<0.01) in the test group; but no changes in the control group. Conclusions: This study shows that enalapril combined with bisoprolol can significantly improve the long term mortality and morbidity in patients with CHF.