大剂量卡托普利治疗CHF伴低血压患者的疗效及安全性观察

Observation of the effect and safety of high doses of captopril in treatment of congestive heart failure associated with hypotension

目的评价大剂量卡托普利治疗充血性心力衰竭(CHF)伴低血压患者的疗效和安全性。方法对46例CHF伴低血压患者经抗心衰治疗2周后,随机均分为两组,分别服用小剂量卡托普利(A组,每天平均56.25 mg)和大剂量卡托普利(B组,每天平均165.65 mg)治疗20周。治疗前后行心功能NYHA分级、6 min步行试验、心脏超声、血压、心率和血液生化检查。结果随访期间死亡3例(A组2例,B组1例),1例猝死,2例因感染诱发心衰加重死亡。两组心功能分级、6 min步行试验均明显改善,以B组改善更明显。与A组比较,B组左室舒张末期内径、左室收缩末期内径明显缩小,左室射血分数明显增加。治疗后,两组心率明显降低,B组肌酐明显升高,但在治疗许可范围内,其余生化指标变化不大。结论大剂量卡托普利能明显改善CHF伴低血压患者的心功能,且安全性好。

[Objective] To evaluate the effect and safety of high doses of eaptopril in treatment of congestive heart failure associated with hypotension. [ Methods ] 46 cases of congestive heart failure associated with hypotension （90-80/70- 60 mmHg） were randomly assigned and then treated with either low doses （56.25 mg/d, group A） or high doses of captopril （165.65 mg/d, group B） after basic heart failure treatment for 2 weeks. Before and 20 weeks after treatment, NYHA classifications, 6-minute walk test, echocardiography, blood pressure, heart rates and blood biochemistry indexes were detected. [Results] During20 weeks＇ follow-up, 3 patients （2 in group A,1 in group B） died, among them 1 due to sudden death, and 2 due to aggravated heart failure. After therapy, NYHA classifications, 6-minute walk distances were improved significantly in both groups, which were more significant in group B than those in group A. The changes of left ventricular end-diastolic diameter, left ventricular end-systolic diameter and left ventricular eject fraction in group B were greater than those in group A. Compared with pretherapy, heart rates decreased remarkably in both groups, but there were no statistical differences between the 2 groups. Serum concentrations of creatinine increased significantly in group B compared with pre- therapy, although in normal ranges. There were no statistical differences in other serum biochemistry indexes pre and post therapy in both groups. [ Conclusion] High doses of captopril are safe in treatment of congestive heart failure associated with hypotension, and have a favorable effect on left ventricular function .