卡托普利与普萘洛尔对慢型克山病患者的治疗效果观察

Effect of Captopril and Propranolol on Chronic Keshan Disease

目的通过观察在口服亚硒酸钠及利尿、强心常规治疗的基础上,联合应用卡托普利、普萘洛尔对慢型克山病的治疗效果,探索一套适宜在克山病病区开展的治疗方案。方法 2010年在陕西省黄陵县及旬邑县2个克山病重病区共选取76例慢型克山病患者,全部患者给予口服卡托普利、普萘洛尔、氢氯噻嗪、螺内酯、地高辛及亚硒酸钠治疗,治疗前、后均记录心功能NYHA分级,并进行心电图检查、胸片及心脏超声检查。对治疗前后心胸比值、心电图及左室射血分数(EF)的变化情况进行统计学分析。结果治疗观察4个月,治疗后心功能改善总有效率达81.1%。治疗后异位心律消失率37.5%,传导阻滞消失率2.7%,ST-T改变消失率26.9%。心功能Ⅱ级、Ⅲ级、Ⅳ级3组治疗后心胸比值较治疗前均减小(t=2.643、6.641、3.005,P<0.05);心功能Ⅱ级组EF值治疗前后无统计学差异(t=-0.15、P>0.05),心功能Ⅲ级、Ⅳ级2组治疗后EF值提高(t=-3.213、-2.140,P<0.05)。结论本研究应用的药物组方治疗慢型克山病能显著改善患者心功能,逆转心脏扩大,提高左室功能,并减少心律失常的发生,对轻、中、重患者均有满意疗效,而且费用低廉、安全性及依从性好,适合在克山病病区推广。

Objective To observe the effect of captopril and propranolol on Chronic Keshan disease, based on taking sedium selenite and conventional treatment（diuresis, cardiotonic）. Search for a suitable treatment protocols of Keshan disease in endemic area. Methods Seventy six patients with CKD were chosen from Huangling and Xunyi in Shaanxi Province in 2010. All patients were given treatment with fixed prescription, which included captopril, propranolol, hydrochlorothiazide, spironolactone and digoxin, while were recorded NYHA cardiac functional grading, electrocardiogram, anteroposterior chest x-ray and echocardiography .To analyze the changes of cardiothoracic ratio and left ventricular ejection fraction（EF） before and after treatment. Results After 4 months of follow-up visit, the total effective rate of heart function improved was 81.1% after treatment. The elimination coefficient of ectupic rhythm,conduction block and ST-T changes were 37.5%, 2.7%, 26.9%. After treatment,cardiothoracic ratio were reduced in cardiac functional grade II group, grade III group and grade IV group（t=2.643, 6.641, 3.005, P〈0.05）. EF has no significant difference prior and post-treatment in grade II group（t=-0.15, P〉0.05）, EF were different before and after treatment in grade III group and gradelV group（t=-3.213, -2.140, P〈0.05）. Conclusions In this study, the fixed prescription .treatment of Keshan disease can significantly improve cardiac function, reversal of heart enlargement, increased left ventricular function, and reduce the incidence of arrhythmias, for light, moderate and severe patients had satisfactory outcome .The fixed prescription costs cheap, good security and compliance, which is suitable for promotion in the Keshan disease endemic area.