美托洛尔治疗慢性心力衰竭患者68例临床疗效观察

Effects of Metoprolol Therapy on Left Ventricular Remodeling and Function in Patients With Chronic Heart Failure

目的 :观察美托洛尔对慢性心力衰竭患者的症状、心功能及心室重塑的影响。方法 :随机选择慢性心力衰竭患者 [左心室舒张末期内径 (LVDD)≥ 5 8mm ,左心室射血分数≤ 0 45 ,NYHA心功能Ⅱ～Ⅳ级 ]经治疗随访达 8个月者共 68例 ,包括治疗组 3 8例 [美托洛尔剂量平均为 ( 4 2 0 75± 12 10 0 )mg/d( 6 2 5mg～2 5mg/次 ,2次 /日或 3次 /日 ) ]和对照组 3 0例。治疗 8个月 ,观察美托洛尔对患者症状、心室重塑及心功能的影响。应用心脏彩色超声仪测定基线值及 2个月、5个月、8个月左心室结构及功能指标变化。结果 :经过 8个月治疗 ,治疗组与对照组比较左心室射血分数升高 ,有极显著性差异 ( 0 5 0± 0 0 2vs 0 41± 0 0 2 ,P <0 0 1) ,左心室收缩末期容积下降 ,有极显著性差异 [( 165 5± 3 9 3 )mlvs( 183 1± 3 9 3 )ml,P <0 0 1] ;治疗组治疗后与治疗前比较左心室舒张末期容积下降 ,亦有显著性差异 (P <0 0 5 )。结论 :在强心 ,利尿 ,血管紧张素转换酶抑制剂治疗基础上 ,应用美托洛尔能显著改善慢性心力衰竭患者的症状、心功能和心室重塑。

Objective: To investigate cardiac function improvement and remodeling process with titrated metoprolol therapy in the patients with chronic heart failure (CHF).Methods: Sixty-eight CHF patients with ejection fraction ≤0.45 and NYHA classes Ⅱ～Ⅳ were enrolled in this study. On a basic of conventional therapy (digitalis,diuretics and angiotenisin-converting enzyme inhibitor),the patients were divided randomly into metoprolol group and control group. The data of ventricular function were measured at baseline,2,5 and 8 months after admission by dynamic three-dimensional echocardiography.Results: The mean dose of metoprolol was 42.075±12.100 mg/d(range 18.3 to 75mg/d). In metoprolol group symptom scores and NYHA class were improved,as reflected by the increased left ventricular ejection praction (0.50±0.02 vs 0.41±0.02, p <0.01) and the decreased left ventricular and systolic volume (165.5±39.3 ml vs 183.1±39.3 ml, p <0.01)compared with those of the control group. Moreover,in the treatment group,the left ventricular end-diastolic volume decreased at 8-months compared with that at baseline( p <0.05).Conclusion: In additional to the conventional therapy (digitalis,diuretics and angiotensin-converting enzyme inhibitors),metoprolol can improve left ventricular performance,and LV remodeling in patients with coronary artery disease and heart failure,and also can improve biological properties of the chronically failing heart.