卡维地洛与美托洛尔治疗高原慢性充血性心力衰竭疗效的对比研究

Comparison of effect of carvedilol and motoprolol on high altitude chronic congestive heart failure

目的比较卡维地洛与美托洛尔治疗高原慢性心力衰竭（CHF）的疗效。方法90例CHF患者随机分成3组：常规治疗组（20例）给予血管紧张素转化酶抑制剂、利尿剂、地高辛等常规心力衰竭治疗。美托洛尔组（34例）、卡维地洛组（36例）在上述治疗基础上分别给予美托洛尔50mg，2次／d；卡维地洛25mg，2次／d口服。随访半年，治疗前、后采用超声心动图测定患者心功能并进行疗效观察。结果治疗后美托洛尔组、卡维地洛组左心室舒张末期内径（LVEDD）[分别为（57．3±6．5）、（57．2±6．9）mm]和左心室收缩末期内径（LVSED）[分别为（46．6±7．0）、（44．0±6．9）mm]显著低于常规治疗组[分别为（64．7±9．1）、（53．4±9．8）mm]，左心室射血分数（LVEF）显著高于常规治疗组[分别为（47．5±8．1）％、（52．9±8．5）％、（42．8±9．2）％]（P均〈0．05）。卡维地洛组LVEF改善优于美托洛尔组（P〈0．05）。死亡情况：常规治疗组4例，美托洛尔组1例，卡维地洛组无死亡。美托洛尔组、卡维地洛组病死率均明显低于常规治疗组（P均〈0．05）。结论美托洛尔、卡维地洛均可明显改善高原CHF患者心功能。卡维地洛疗效及耐受性略优于美托洛尔。

Objective To compare the effect of carvedilol and motoprolol on high altitude chronic congestive heart failure （CHF）. Methods Ninety patients with high altitude chronic CHF were divided into three groups randomly：Twenty patients in the regular treatment group treated with angiotensin-converting enzyme inhibitor （ACEI） , diuretics and digoxin;motoprolol （50 mg twice daily） was given in the motoprolol group （34 cases） additional to regular treatment; carvedilol （25 mg twice daily） was given in the carvedilol group （36 cases ） additional to regular treatment. All the patients were followed up for six months and measured the changes of cardiac function by echocardiography. Results Left ventricular end-diastolic dimension （LVEDD） was （ 57. 3 ± 6. 5 ）mm and （ 57.2 ±6. 9 ） mm in the carvedilol group and the motoprolol group respectively, and left ventricular end-systolic dimension （ LVESD ） was （ 46. 6 ± 7. 0 ） mm and （ 44. 0 ±6.9 ） mm in the carvedilol group and the motoprolol group respectively, which were all significantly smaller than that in the regular treatment group （ [ 64. 7 ± 9. 1 ] mm and [ 53.4 ±9. 8 ] mm for LVEDD and LVESD, respectively） （ Ps 〈 0. 05 ）. Left ventricular ejection fraction （LVEF） in the carvedilol group and the motoprolol group （ [ 47. 5 ± 8. 1 ] % and [ 52.9 ± 8.5 ] %, respectively） was higher than that in regular treatment group （ [ 42. 8 ±9. 2 ] % ） （ Ps 〈0. 05 ）. The improvement of LVEF in the carvedilol group was better than that in the motoprolol group （ P 〈 0. 05 ）. One case died in the motoprolol group and no death in the carvedilol group,4 cases died in the regular treatment group,the mortality in the motoprolol group and the earvedilol group was significantly lower than that in the regular treatment group. Conclusion Carvedilol and motoprolol significantly improved cardiac function in high latitude CHF patients, and the effect of Carvedilol is slightly better than that of motoprolol.