卡维地洛治疗老年人慢性心力衰竭患者的疗效和安全性观察

Research of the Efficacy and Safety of Carvedilol in Elderly Patients with Chronic Heart Failure

目的观察和评价卡维地洛干预老年人慢性充血性心力衰竭患者的疗效、耐受性和安全性。方法采集符合入选标准的老年人(≥65岁)慢性充血性心力衰竭患者54例,随机分为卡维地洛治疗组28例和对照组26例,两组均予心力衰竭常规治疗,实验组加用卡维地洛。卡维地洛由小剂量开始(2.5mg,2次/天),每周剂量倍增一次,逐渐递增至最大耐受量(20mg,2次/天)。疗程6个月,在两组治疗前及治疗后3个月及6个月分别记录患者的NYHA心功能分级的变化,检测心脏左室射血分数(LVEF)及左室短轴缩短率(FS),记录6min步行试验的变化,并检查对比肝、肾功能、空腹血糖、血常规的变化等。结果实验结束,两组的左室短轴缩短率(FS)、左室射血分数(LVEF)较治疗前均有增加,治疗6个月后两组间差异显著(P<0.05);6min步行试验距离,治疗后两组间差异显著(P<0.05)。实验组无1例能耐受目标剂量(40mg/d),不良反应主要为头晕、乏力、心动过缓和低血压;实验组与对照组空腹血糖、白细胞、血小板及肝肾功能均无显著性变化。结论在老年人心力衰竭常规治疗基础上加用卡维地洛有显著疗效。卡维地洛治疗老年人心力衰竭无严重的不良反应。老年心力衰竭患者应用卡维地洛的耐受剂量显著小于目标剂量。

Objective To evaluate the efficacy and the safety of carvedilol in chronic heart failure （CHF） treatment in the elder. Methods 54 cases of old patients （〉65y） according with criteria for the standard were enrolled. 28 were assigned to carvedilol group and 26 to control group; Carvedilol was titrated from low dose（2.5mg,bid） to the target dose or maximal tolerance dose（20mg,bid） in addition to standard therapy in carvedilol group; Standard therapy was merely given in.control group. All patients were examined with LVEF and FS by echocardiography, 6-minnte walk test, liver function tests, renal function test, serum glucose test and full blood count etc. Three times within six months to assess the changing of the heart function ratings. Results Compared with the beginning of the study, FS. LVEF significantly increased in both groups,and there were significant differences between both groups at the end of the research （P〈0.05）; 6-min walk test showed that distance walked significantly increased in both groups ,there were significant differences between both groups. No one could tolerance with carvedilol target dose （20rag,bid） in the study; No significant changes of liver, renal function, blood routine test, electrolyte and blood sugar were found in both groups. The side effect of dizziness, tiredness, lower blood pressure and bradycardia were relatively more often in carvedilol group. Conclusion Carvedilol can significantly increase ratings of heart function in the elder with CHF. Carvedilol is safe for the elder. The maximal tolerance dose is significantly smaller than the target dose in elder.