达利全对充血性心力衰竭患者左室舒张功能的影响

Influence of Dilatrend on diastolic function of left ventricle in patients with congestive heart failure

目的:通过超声心动指标的监测,客观评价达利全对左室舒张功能的影响。方法:入选68例患者:缺血性心脏病38例,高血压性心脏病20例,扩张型心肌病10例,符合美国纽约心脏病学会(NYHA)心功能分级:Ⅲ级42例,Ⅳ级(无明显钠、水潴留)26例,所有患者入院后都接受心衰常规治疗(休息、限盐、应用血管紧张素转换酶抑制剂、利尿剂、强心甙、硝酸酯类等),达利全组(n=30),加用达利全,初始剂量为3.125mg/d,2次/d,2周后增至6.25mg,2次/d,以后根据耐受情况逐渐上调,每2周倍增,逐渐增加至患者最大耐受量。详细观察并记录二组患者血压、心率、心律,心衰症状及体征的变化,评价心功能的变化。分别于治疗前和治疗4个月、1年后作超声心动图检查测定EDV、ESV、A波、E波、E/A、Mass、DT,IVRT、PAPs、EF,评价心脏舒张功能。结果:①心率、血压的变化:达利全组治疗后心率比治疗前明显减慢(P<0.05),而且也较对照组控制好(P<0.05);达利全组治疗后血压虽有下降趋势,但差异无统计学意义。②超声心动图的变化:达利全组治疗4个月后A、E/A、DT、IVRT、PAPs较常规治疗组差异有统计学意义(P<0.05),达利全组治疗1年后ESV、EF、E、A、E/A、DT、IVRT、PAPs较常规治疗组差异有统计学意义(P<0.05)。③心功能的变化:两组治疗前后的心功能:H=30.6029,P<0.001。治疗前两组之间d=3.1429,P>0.05;达利全组和对照组治疗前后比较,P<0.05。结论:心衰患者包括中、重度心衰(无明显钠、水潴留)患者短期及长期应用达利全均可改善左室舒张功能,应用时间越长,获益越多。

Objective To evaluated early-and long-term diastolic cardiac modification by an echo Doppler method during Dilatrend therapy in patients with advanced congestive heart failure（CHF）.Method 68 patients with severe but stable CHF having systolic and diastolic dysfunction caused by idiopathic or ischemic cardiomyopathy were studied.30 patients received routine treatment plus Dilatrend（group 1） and the others continued routine therapy（group 2）.We evaluated LV volumes,LV mass,LV ejection fraction（EF）,and the following transmitral filling parameters： early wave（E）,atrial wave（A）,E/A ratio,deceleration time（DT）,and isovolumetric releasing time（IVRT） in all subjects.Results After 4 months of therapy,group 1 showed a significant increase of A wave,DT,IVRT,and a significant reduction of E/A ratio with respect to group 2.Further improvement was observed at 12 month.Conclusion Dilatrend can improve dilastolic function in CHF patients with severe diastolic and systolic impairment at early-and long-term.