不同剂量卡托普利治疗小儿慢性充血性心力衰竭临床研究

Clinical effect and the tolerance of different captopril dosage in the therapeutics of chronic congestive heart failure in children

目的 探讨不同剂量卡托普利治疗小儿慢性充血性心力衰竭 (CHF)的临床疗效及耐受性。方法 对 6 0例 CHF患儿在常规心衰治疗基础上加用卡托普利 ,并随机分为两组。卡托普利剂量为 A组 0 .2～ 0 .3mg/kg,B组 1.0～ 2 .0 mg/ kg,均每日 2次。观察两组心功能分级、心胸比率 (CTR)、超声心动图改变。结果 与 A组比较 ,B组心功能明显改善 (P<0 .0 5 ) ,CTR明显缩小 (P<0 .0 1)。两组超声心动图检查均示舒张期室间隔厚度(IVST)无改变 ;与 A组比较 ,B组射血分数 (EF)增高 (P<0 .0 5 ) ,左室缩短率 (FS)明显增高 (P<0 .0 1) ,左室舒张末内径 (L VDd)缩小 (P<0 .0 1)。结论 不同剂量卡托普利均明显改善 CHF患儿的心功能 ,缩小 CTR及L VDd,缩小肝脏 ,以较大剂量卡托普利的临床疗效显著 ,多数患儿耐受性好 ,未出现明显的药物毒副作用。

Objective To explore the clinical effects and the tolerance of different captopril dosage in the therapeutics of chronic congestive heart failure(CHF) in children.Methods 60 children with CHF were treated using routine therapy with complement of captopril,which were divided randomly into two groups with 30 cases in each group:A group treated with low dose captopril (0.2～0.3mg/kg bid) and B group treated with high dose captopril (1.0～2.0mg/kg bid).The grades of heart function,cardiothoracic ratio(CTR) and the echocardiogram [interventricular septal thickness (IVST),ejection fraction (EF),fraction shortening (FS),left ventricular diastolic diameter (LVDd)] were detected in both groups.Results The improvement of heart functions in B group was more obvious than that in A group(P<0.05).The cardiothoracic ratio in B group was declined( P<0.01 ).The changes of echocardiogram:the IVST did not change.EF in B group were higher than those in A group(P<0.05) and the FS in B group were significantly higher than those in A group(P<0.01) and the LVDd in B group were smaller than those in A group(P<0.01).Conclusion Administering different dosage of captopril can improve heart function as well as reduce the CTR and the LVDd in CHF children.High dosage captopril may be more effective than low dosage and the tolerance with high dosage captopril is good in many of the CHF children with no side-effect during the period of therapy and follow-up.