曲美他嗪联合氯沙坦治疗慢性心衰的临床疗效评估

Clinical significance of losartan combined with trimetazidine for chronic congestive heart failure

目的评价曲美他嗪与氯沙坦(ARB)联合治疗慢性心力衰竭的临床疗效及安全性。方法选择2008年5月至2009年9月间入院治疗的78例无休克,无严重肝肾功能不全,无低钾血症的慢性心力衰竭患者随机分成两组。对照组(n=39),患者接受常规强心、利尿、扩血管抗心衰治疗;联合治疗组(n=39)在常规治疗的基础上加用曲美他嗪20 mg,3次/d,ARB 50 mg,1次/d,16周为一个疗程。治疗前后测血压、心率、超声心动图、血生化指标。结果联合治疗组治疗16周后临床综合疗效总有效率和显效率均高于对照组,差异有统计学意义(P<0.05);两组患者治疗16周后后,纽约心脏协会心功能分级(NYHA分级)均有所改善,但仅联合治疗组治疗后与治疗前比较差异有统计学意义(P<0.05);联合治疗组患者左心室射血分数显著升高(P<0.05),左心室舒张末期内径显著降低(P<0.05);治疗后两组6 min步行实验均显著增加,但联合治疗组优于对照组,差异有统计学意义(P<0.05)。结论慢性心力衰竭患者在常规治疗基础上,长期服用曲美他嗪与ARB治疗心力衰竭疗效确切,能明显改善慢性心力衰竭患者的心功能及生活质量,值得推广应用。

Objective To investigate the clinical efficacy and safety of losartan combined with trimetazidine for chronic heart failure.Methods 78 patients with chronic heart failure were randomly divided into two groups： combined therapy group（n=39） and control group（n=39）.Control group received cardiac,diuretic and other conventional treatment;combined therapy group received trimetazidine 20 mg,tid,losartan 50 mg,qd,16 w as a course,on the basis of conventional therapy.Blood pressure,heart rate,echocardiography,blood biochemistry,efficacy,adverse reactions were all observed before and after treatment.Results After 16 weeks treatment,the total effective rate in combined treatment group markedly higher than control group（P0.05）.NYHA classification had improved,but only combined therapy group compared with before treatment after treatment difference was statistically significant（P0.05）;combined treatment group were significantly higher in patients with left ventricular ejection fraction（P0.05）,left ventricular end diastolic diameter decreased significantly（P0.05）;6MWT were significantly increased in both groups,but the combined treatment group higher than the control group,the difference was statistically significant（P0.05）.Conclusion Long-term use of losartan combined with trimetazidine in the treatment of heart failure with losartan is effective,which can improve cardiac function and life quality,should be widely applied.