老年重症心力衰竭130例急诊内科治疗观察

Emergency Treatment for 130 Cases of Aged Patients with Congestive Heart Failure

目的观察厄贝沙坦氢氯噻嗪早期联合美托洛尔治疗老年重症心力衰竭的疗效。方法将130例年龄70.5±5.9岁,NYHA 心功能分级的重症充血性心力衰竭(CHF)患者分为3组,即厄贝沙坦氢氯噻嗪联合美托洛尔治疗组(44例),厄贝沙坦氢氯噻嗪治疗组(46例)和对照组(40例),随访1年,以 NYHA 心功能分级,超声心动图所示左室射血分数(LVEF)年住院次数,年住院日和死亡例数来评估治疗效果,并探讨 B 型利钠肽(BNP)在心力衰竭处理中的价值。结果 0.5年时联合治疗组与厄贝沙坦氢氯噻嗪组间 BNP 存在统计学意义(P<0.05)。心功能分级、LVEF 无统计学意义;而联合治疗组及厄贝沙坦氢氯噻嗪组的心功能分级、LVFF、BNP 与对照组存在统计学意义(P<0.05或 P<0.01)。1年时联合治疗组与厄贝沙坦氢氯噻嚎组的心功能分级、LVEF、BNP 存在统计学意义(P<0.05或P<0.01);而厄贝沙坦氢氯噻嗪组和联合治疗组的心功能分级、BNP、LVEF 与对照组存在统计学意义(P<0.01)。联合治疗组年住院次数及住院日、死亡数最少。结论早期厄贝沙坦氢氯噻嗪联合美托洛尔治疗老年重症 CHF 比单用厄贝沙坦氢氯噻嗪有更好的临床疗效,其疗效在0.5年后出现,且能很好地提高患者生活质量。

Objective To investigate the treatment of gerontic patients with congestive heart failure by combination of metoprolol and irbesartan ,hydrochlorothiazide in early stage. Methods 130 cases of severe congestive failure with NYHA hart function grade were divided into three groups： Irbesartan hydrocblorothiazide group（ n = 46） , combination of irbesartan hydrochlorothiazide and metoprolol group （ n = 44） and control group（ n = 40）. All patients were followed up for 12 months,including their heart functions of LVEF by echocardiography, date in hospital treatment stay and mortality. BNP value in the treatment of congestive heart failure was also investigated. Results In half year,there was the significant difference between combination group and irbesartan hydrochlorothiazide group in BNP（ P 〈0. 05） ,but there was no difference between two groups in heart function and LVEF. Compared to control group, there were significant differences in heart functions, BNP and LVEF both in combination group and irbesartan hydrochlorothiazide group ＇（ P 〈 0. 05 or 0. 01 ）. After one year, there were significant differences between combination group and irbesartan hydrochlorothiazide group （ P 〈 0. 05 ） in heart functions, LVEF and BNP（ P 〈 0.01 ）. Compared to control group, there were also highly significant in heart functions BNP and LVEF in combination group and irbesartan hydrochlorothiazide group （ P 〈 0. 01 ）. Combination group was the lowest group of date of hospital treatment stay. Conclusion Compared to irbesartan hydrochlorothiazide capsules therapy alone, better clinical results achieved by combination therapy of irbesartan hydrochlorothiazide capsules and metoprolol in gerontic patients with severe congestive heart failure at half year. Life quality of patients also improved by the combination therapy.