琥珀酸美托洛尔控释片对充血性心力衰竭患者心室重构及心功能的影响

Effects of Controlled-release Metoprolol Therapy on the Ventricular Remodeling and Cardiac Function in the Patients of Chronic Congestive Heart Failure

目的探讨琥珀酸美托洛尔控释片对慢性充血性心力衰竭患者心功能的影响。方法慢性充血性心力衰竭患者60例,心功能(NYHA)Ⅱ～Ⅳ级,常规治疗基础上随机分为治疗组和对照组。治疗6个月,治疗组给与琥珀酸美托洛尔控释片,观察其对心室重塑、心功能的影响。应用心脏彩色超声仪测定治疗前后左室结构及功能指标变化,临床评价心功能改善情况。结果治疗6个月,美托洛尔治疗组症状和心功能改善,与对照组比较左室射血分数上升[(36．1±1．9)%vs(29．5±1．70%,P＜0．01]、左室收缩末容积下降[(165．5±45．0)ml vs(181．0±44．0)ml,P＜0．05];左室舒张末容积有下降趋势(P＜0．05);但两组间无统计学差异。结论在强心、利尿、血管紧张素转化酶抑制剂基础上,应用琥珀酸美托洛尔控释片能显著改善充血性心力衰竭患者心功能,改善心室重塑。

Objective To investigate cardiac function improvement with titrated controlled-release metoprolol therapy in the patients of chronic congestive heart failure（CHF）. Methods In 60 patients with CHF, the ejection fraction of cardiac function was （NYHA class） classⅡ -Ⅳ ≤0.45. On a basic medical therapy including digitalis, diuretics and ACEI, they were divided randomly into metoprolol group and control group for a 6-momth follow-up period. The data of ventricular function were measured by 20-echcar- diography after admission. Results In metoprolol group symptom scores and NYHA class improved, as reflected by the increased left ventricular ejection fraction[ （ 36. 1 ± 1.9 ） % vs （ 29.5 ± 1.70%, P 〈 0.01 ] and the decreased left ventricular end systolic volume[ （ 165.5 ± 45.0 ） ml vs （ 181.0 ± 44.0 ） ml, P 〈 0.05 ] ; compared with those in control group. Moreover, in treatment group, the left ventricular end-diastolic volume decreased at 6-month compared with that at baseline（P 〈0.05） ,but there was no significant differences between the two groups. Conclusion Based on the medication of digitalis, diuretics and angiotensin-conver- ting enzyme inhibitors controlled-release, metoprolol therapy can improve left ventricular performance in patients o congestive heart failure and also improve the biological properties of the chronically failing heart.