卡维地洛治疗慢性心力衰竭疗效观察

Carvedilol in the treatment of chronic heart failure.

目的 研究卡雏地洛治疗慢性心力衰竭的疗效及其耐受剂量，用药的安全性。方法患者87例心功能分级（NYHA）Ⅱ级15例，Ⅲ级61例，Ⅳ级11例；LVEF〈45％。随机分成两组，入选患者病情基本稳定无明显液体潴留，在常规应用血管紧张素转换酶抑制剂、利尿剂、洋地黄基础上，由小剂量开始服用卡雏地洛3．125mg，2次／d。可耐受者每2～4周增加剂量，直至患者的最大耐受量。目标剂量为50mg／d。随访时间为6～18个月，以核素心肌显像观察左室功能和容积。结果 经过6～18个月的观察和治疗，卡雏地洛组临床症状和心功能明显改善，LVEF增加，由（23．31±6．0）％增至（43．53士4．6）％（P=0．0012）。左室收缩末期容积由（146．31士30．32）ml减至（69．56士14.27）ml（P=0.0026）。左室舒张末期容积减少由（189．97±29．9）ml减至（117．92±19．14）ml（P=0．0037）。卡雏地洛组有53例（60．9％）耐受目标剂量（50mg／d），用药中无特殊不良反应。最常见的不良反应是头晕，未出现肝、肾功能损害及血脂、血糖、电解质和血象的变化。结论 在心力衰竭标准治疗基础上应用卡雏地洛，可以提高射血分数，缩小扩大的心室腔，改善心功能，改善心室重塑，用药安全、有效。

Objective To study the efficacy and safety of carvedilol in the treatment of chronic heart failure. Methods Eighty-Seven patients were divided into two groups. The NYHA class ification was from Ⅱ to Ⅳ （ including Ⅱ in 15 cases,Ⅲ in 61 cases and IV in 11 cases） ; the ejection of them was 〈45%. On a basic medical therapy including digitalis diuretics and ACE-I,carvedilol was titrated from low dose（ 3. 125 mg Bid） to target dose. The target dose was 50 mg every day. They were divided randomly into carvedilol group and control group for 6 to 18 months follow-up period. The data of left ventricular function and volume were measured by radionuclide ventriculography. Results After 6 to 18 months,in carvedilol group symptom scores and NYHA class ification improved, as reflected by the increased left ventricular ejection by （ 23.31 ± 6.0 ） % to （ 43.53 ＋ 4.6 } % （ P = 0. 0012 }, both the decreased left ventricular end-systolic and the decreased left ventricular end-diastolic volume was from[ （ 146.31 ± 19.14 ） ml to （ 69.56 ±14.27 ） ml, P = 0. 0026 ], and form [ （ 189.97 ± 29.9） ml to （ 117.92 ± 19. 14 ） ml, P = 0.0037 ]. In carvedilol group 53 patients （ 60.9% ） were tolerant target does （50 mg/d ）. All the patients hadn＇ t special side effect. The common symptom was dizziness. No significant change of liver,renal function,bloed sugar, blood lipid,electrolyte and blood routine test occurred in carvedilol group. Conclusion Based on the standard medical therapy, carvedilol can improve left ventricular performance, reverse LV remodeling in patients with chronic heart failure. Carvedilol is safe and efficacious for the therapy of chronic heart failure.