氯沙坦早期联合美托洛尔治疗老年重症心力衰竭的临床观察

Effect of losartan and metoprolol on heart function in aged severe chronic heart failure

目的观察氯沙坦早期联合美托洛尔治疗老年重症心力衰竭的疗效。方法65例年龄(72.5±6.9)岁、NY-HA心功能分级的重症充血性心力衰竭(CHF)患者分为三组,即氯沙坦联合美托洛尔治疗组(22例)、氯沙坦治疗组(23例)和对照组(20例),随访1 a,以NYHA心功能分级、超声心动图所示左室射血分数(LVEF)、年住院次数、年住院日和死亡例数来评估治疗效果,并探讨B型利钠肽(BNP)在心力衰竭处理中的价值。结果0.5 a时联合治疗组与氯沙坦组间BNP存在统计学意义(P<0.05),心功能分级、LVEF无统计学意义;而联合治疗组及氯沙坦组的心功能分级、LVEF、BNP较对照组存在统计学意义(P<0.05或P<0.01)。1 a时联合治疗组较氯沙坦组的心功能分级、LVEF、BNP存在统计学意义(P<0.05或P<0.01);而氯沙坦组及联合治疗组的心功能分级、BNP、LVEF较对照组存在统计学意义(P<0.01),联合治疗组年住院次数及住院日最少。结论早期氯沙坦联合美托洛尔治疗老年重症CHF比单独应用氯沙坦有更好的临床疗效,其疗效在0.5 a后开始出现,且很好地提高患者生活质量。

Objective To investigate the therapeutic effect of early metoprolol combination on losartan treated gerontic patients with severe chronic heart failure. Method 65 cases （ aged 72.5 ± 6.9 ） of severe chronic heart failure with NYHA heart function grade were divided into three groups ： losartan group （ n = 23 ） , losartan and metoprolol combination group （ n = 22 ） and control group （ n = 20）. All patients were followed up for 12 months, including their heart functions, LVEF by echocardiography, in hospital treatment days and times, and mortality. BNP value in the treatment of chronic heart failure was also investigated. Results After half year petied, there were significant differences between combination group and losartan in BNP （P 〈0.05 ）, there were no differences between combination group and losartan in heart function and LVEF, but there were significant differences in heart functions and LVEF in combination group and losartan compared to control group （P 〈0.05 ）, also highly significant in BNP （P 〈0.01 ）. After a year, there were significant differences between combination group and losartan （ P 〈0.05） in heart functions and LVEF, also highly significant in BNP （ P 〈0.01 ） and there were also highly significant in heart functions, BNP and LVEF in combination group and losartan compared to control group （ P 〈 0. 01）, combination group was the lowest group of in hospital treatment days and times. Conclusions Better clinical results achieved by losartan and metoprolol combination therapy in gerontic patients with severe chronic heart failure compared to losartan therapy alone, life quality of patients also improved by the combination therapy.