代文和洛丁新对充血性心力衰竭血流动力学影响的比较

Comparison between the effects of diovan and lotensin on the hemodynamics in patients with congestive heart failure

目的 :比较血管紧张素转换酶抑制剂 (ACEI)和血管紧张素 1型 (AT1)受体拮抗剂对充血性心力衰竭 (CHF)患者血流动力学的作用。方法 :90例 CHF患者随机分为 AT1受体拮抗剂代文组 (口服代文80 m g/ d)、ACEI洛丁新组 (口服洛丁新 10 mg/ d)和常规治疗对照组 ,各组疗程均为 1个月。治疗前后心功能按NYHA分级 ,超声心动图检测左室内径 (L V)、心排血量 (CO)、左室射血分数 (L VEF)及舒张早期血流 /舒张末期血流 (E/ A) ;治疗前后拍摄 X线胸片测定心 /胸比。结果 :代文组和洛丁新组患者治疗前后的心功能及血流动力学参数差异均有显著性 (P均 <0 .0 5 ) ,常规治疗对照组患者治疗前后比较心功能、心 /胸比、CO和 L VEF差异均有显著性 (P均 <0 .0 5 ) ,而 E/ A差异无显著性 (P>0 .0 5 )。代文组和洛丁新组心功能及血流动力学参数与常规治疗对照组比较差异均有显著性 (P均 <0 .0 5 )。代文组与洛丁新组治疗后心功能及血流动力学参数比较差异也均有显著性 (P均 <0 .0 5 )。结论 :代文和洛丁新对 CHF均有效 ,以代文效果更好。

Objective: To compare the effects of angiotensinconverting enzyme inhibitor(ACEI) and angiotensin Ⅱ type 1(AT1) receptor antagonist on hemodynamics in patients with congestive heart failure. Methods: A total of 90 patients with congestive heart failure were randomly divided into AT1 receptor antagonist group which was treated with diovan 80 mg/d orally, ACEI group which was treated with lotensin 10 mg/d , and conventional treatment group as control. The therapeutic course was 1 month for three groups. Before and after treatment of one month, cardiac function of NYHA grade was observed, left ventricular dimension(LV) , cardiac output(CO), left ventricular ejection fraction(LVEF), and the early diastolic flow/the late diastolic flow or velocity(E/A) were measured by ultrasonic cardiography and heart/chest ratio were detected by Xray image of chest. Results: All the indexes of cardiac function and hemodynamics were changed significantly before and after treatment with diovan or lotensin (all P <0 05), meanwhile the indexes of cardiac function, heart/chest ratio, CO and LVEF were changed significantly in conventional treatment control group(all P <0 05) but no significant differentce was found in E/A( P >0 05). After treatment, the changes in indexes of cardiac function and hemodynamics were significantly larger in patients treated with diovan or lotensin compared than those of in conventional treatment group(all P <0 05). Conclusion: Diovan and lotensin are effective in treatment for patients with congestive heart failure, but the effect of diovan is much more better than that of lotensin.