常规应用螺内酯联合依那普利治疗老年扩张型心肌病心力衰竭

Spironolactone combined with Enalapril in treatment of heart failure of dilated cardiomyopathy in elders

目的评价螺内酯联合依那普利治疗老年人扩张型心肌病(DCM)心力衰竭的有效性和安全性。方法以148例老年DCM心力衰竭患者作研究对象,按随机化原则分为观察组(74例)和对照组(74例)。对照组为依那普利,加上基础用药(地高辛、双氢克尿噻);观察组为对照组用药加上螺内酯。治疗6周后复查两组的动态心电图、超声心动图。结果治疗后两组的左室射血分数(LVEF)均有增加,左室收缩末期容积(LVESV)和左室舒张末期容积(LVEDV)均有减少,24 h室性早搏(VA)数也均有减少;观察组与对照组比较,LVEF显著增加。两组均未发现高血钾及肝肾功能损害。结论在老年DCM心力衰竭常规用药的基础上,常规加用螺内酯联合依那普利的治疗有效、安全,可显著改善左室重构和防治猝死。

AIM To evaluate the efficiency and safety of Spironolactone combined with Enalapril in the treatment of heart failure of dilated eardiomyopathy （DCM） in elders. METHODS 148 elders with heart failure of DCM were randomly divided into the observation group （ n = 74） and control group （ n = 74）. Patients in control group were treated with Enalapril plus digoxin and hydrochlorothiazide and patients in observation group were treated with drugs used in control group plus Spironolactone. After 6- week treatment, Holter and ultrasound cardiography were performed. RESULTS After treatment, patients in two groups showed increased left ventrieular ejection fraction （LVEF）, decreased left ventricular end-diastolic volume （LVEDV） and decreased times of ventrieular arrhythmia in 24 h. Compared with the control group, the changes were more significant in observation group（ P 〈0.05 ）. No hyperopotassium and impairment of liver and kidney functuins found in either group. CONCLUSION Spironolaetone combined with Enalapril plus basic drugs benefit the reconstruction of left ventrieular and effectively prevent sudden death.