阿托伐他汀联合曲美他嗪治疗老年冠心病左心功能不全的疗效观察

Observation of atorvastatin combined with trimetazidine on the treatment in left ventricular insufficient senium patients with coronary heart disease

目的本研究旨在观察在传统治疗基础上阿托伐他汀联合曲美他嗪治疗老年冠心病合并左心功能不全的中远期疗效(24个月)。方法 90例老年冠心病心功能不全患者随机分为治疗组(45例)和对照组(45例),所有患者入选后均应用洋地黄制剂、ACEI/ARB、醛固酮拮抗剂、β受体阻滞剂及利尿剂等常规治疗。治疗组在常规治疗基础上予阿托伐他汀10 mg 1次/d合用曲美他嗪20 mg 3次/d,用药观察期为24个月。比较两组治疗前后纽约心脏协会心功能分级、四维超声测量的左心室舒张末期内径、左心室收缩末期内径和左心室射血分数。结果治疗组与对照组6个月、12个月、18个月、24个月超声测量的左心室收缩功能测定比较,差异均有统计学意义(P<0.05)。治疗组与对照组6个月时NYHA心功能分级的比较,差异无统计学意义(P>0.05);12个月、18个月、24个月时NYHA心功能分级的比较差异均有统计学意义(均P<0.05)。结论在传统治疗基础上阿托伐他汀联合曲美他嗪可进一步改善老年冠心病合并左心功能不全患者的心功能,中远期疗效满意,值得临床推广。

Objective To investigate the long-term （24 months） clinical effect of atorvastation combined with trimetazi dine on heart function of left ventrieular insufficient senium patients with coronary heart disease. Methods Ninety se- nium patients with coronary heart disease combined with left ventricular insufficiency were randomly divided into treatment group（n=45） and control group （n=45）. All patients were enrolled after the application of digitalis prepara- tions,ACEI/ARB ,aldosterone antagonists,beta-receptor blockers and diuretics and other conventional treatment. Be- sides general treatment, atorvastatin 10mg 1 times/d combined with trimetazidine 20 mg 3 times/d were used in treat ment group. The observation period was 24 months. New York Heart Association （NYHA） heart function classifica tion, four-dimensional ultrasound measurement of left ventricular end diastolic diameter （LVEDD） , Left ventricular end systolic diameter （LVESD） and left ventricular ejection fraction （LVEF） were compared between the two groups before and after treatment. Results Better improvements on uhrasonic measurement of left ventricular systolic function （LVEDD, LVESD,LVEF） in treatment group were observed when compared with control group at the 6 months, 12 months, 18 months and 24 months, the difference was statistically significant（P 〈 0.05）. At the 6 months, there was no statistically significant difference between two groups on NYHA heart function classification （P 〉 0.05）, but when corn pared at 12 months, 18 months and 24 months, the difference was statistically significant（P 〈 0.05）. Conclusion Atorvas- tatin combined with trimetazidine can further improve the heart function of senile patients with coronary heart disease combined with left ventricular insufficiency based on the traditional treatment , the long-term effect is satisfied,such approach is worth spreading.