步长稳心颗粒并美托洛尔对慢性心力衰竭伴心房颤动的疗效

Effects of wenxin keli combine with metoprolol on chronic heart failure patients with chronic atrial fibrillation

目的：探讨步长稳心颗粒联用美托洛尔对慢性心力衰竭（CHF）伴慢性心房颤动（AF）患者的疗效。方法：选择CHF伴慢性AF98例，随机分为治疗组（50例）和对照组（48例）。两组均常规使用地高辛等常规用药，治疗组加用美托洛尔（12．5～50mg／d）及步长稳心颗粒（27g／d）。观察两组1月疗效。并随访半年心脏原因所致再住院率、死亡率。结果：治疗1月后，治疗组患者静息心室率（HR）和运动前、后即刻心室率差值（HD）显著降低，6min步行距离（m），左室射血分数（LVEF）显著增加，心功能NYHA分级，生活质量（QOL）显著改善（P〈0．05～〈0．01）。对照组的上述参数除HD外亦有显著改善（P〈0．05），但HR、HD、6min步行距离改善显著次于治疗组（P〈0．05）。随访半年，和对照组相比，治疗组患者因心力衰竭再住院率较低（14．0%：27．1%。P〈0．05），死亡率亦较低（6％：14．6％，P〈0．05）；NYHA分级、6min步行距离、LVESV、LVEDV、LVEF、QOL评分明显优于对照组（P〈0．05）。结论：对于慢性心力衰竭合并心房颤动患者，在常规治疗的基础上，步长稳心颗粒联用美托洛尔1个月仅HR，HD。6min步行距离改善显著优于对照组。而半年后心功能、生活质量都明显优于对照组。

Objective ： To investigate the short-term effects and long-term prognosis of wenxin keli with metoprolol on chronic heart failure （CHF） patients with chronic atrial fibrillation （AF）. Methods： Ninety-eight patients with CHF and AF were randomly divided into the treatment group treated with wenxin keli （27 g/d） and metoprolol （12.5～50 mg/d, 50 cases）, and the control group （48 cases）. The general therapy included digoxin etc. was performed in two groups. Results： The ventricular rates at rest （HR） decreased, the walking distance of 6 min and LVEF （left ventricular ejection fraction） increased, the NYHA heart function class and quality of life （QOL） improved obviously （P〈0. 05～〈0.01） in treatment group one month after treatment. Above station parameters also obviously improved （P〈0.05） in control group, but HR, the diversity of ventricular rate before and after walk （HD） and walking distance of 6 min less than those of treatment group （P〈0. 05）. In 6 months follow up period, the rehospitalization rate （14%） and mortality （6%） were less than those of control group （P〈0.05） ; the improved of walking distance of 6 min, NYHA heart function class, LVESV, LVEDV and QOL were more than those of control group in treatment group （P〈0.05）. Conclusion：Based on the routine therapy the wenxin keli with metoprolol can improve the short-term effects and long-term prognosis on CHF patients with AF, but the long-term prognosis is obviously better than that of control group.