美托洛尔治疗慢性心力衰竭的疗效观察

The Effect of Metoprolol in the Treatment of Chronic Heart Failure.

目的探讨酒石酸美托洛尔用于治疗慢性心力衰竭的疗效及其耐受剂量，用药的安全性。方法患者96例心功能分级（NYHA）II级18例，III级64例，IV级14例；LVEF〈44％。随机分成两组，所有入选患者病情大致稳定而且无明显液体潴留，在一般使用血管紧张素转换酶抑制剂，利尿剂以及洋地黄基础上，由小剂量开始服用美托洛尔6．25mg，2次／d。能够耐受者每2~4周逐渐增加剂量，直至患者最大耐受量。目标剂量为50mg／d．随访时间为6-18个月，以心脏彩超观察左心室的功能和容积。结果经过6-18个月的观察和治疗，美托洛尔组临床症状和心功能显着改善，LVEF．增加，由（23．42±6．1）％增至（43．64±4．7）％（P=-0．0013）。左室收缩末期容积由（146．42±30．43）mL减至（69．67士14．38）mL（P=0．0027）。左心室舒张末期容积减少由[（189．86土29．8）mL减至（117．81±19．13）mL（P=-0．0038）]。美托洛尔组有58例（60．4％）耐受目标剂量（50mg／d），在用药中无特别不良反应。常见不良反应是头晕疲倦无力，未出现肝功能、肾功能损害及血脂、电解质和血象的变化。结论在心力衰竭标准治疗基础上常规使用美托洛尔，能够有效提高射血分数，缩小扩大的心室腔，改善心功能以及心室重塑，用药安全、有效。

Objective To study the efficacy and safety of metoprolol in the treatment of chronic heart failure. Methods Eighty-Seven Patients were divided into two groups. The NYHA class ification was from II to IV（in eluding I1 in 15 cases, III in 61cases and IV in llcases）; Their ejection 〈44%. In a basic medical treatment digitalis diuretics and ACE-I metoprolol titated from low dose （6.25mg bid） to the target dose. The target dose of 50 mg per day. They were randomly divided into the follow-up period of 6 to 18 months of the metoprolol group and the control group. The color sonograhy determination of left ventricular function and volume data. Results after 6 to 18 months, the treatment group symptom scores and functional classification improved by increased left ventrieular ejection reflex （23.42 ± 6.1） - （43.64 ± 4.7）% （P=0.0013）.both the decreased left ventricular end-systolic and the decreased left ventricular end-diastolic volume was from [ （146.42±30.43）mL to （69.67±14.38） mL, P=0.0027） ],and form [（189.86±29.8）mL to （117.81±19.13） mL, P=0.0038].In metoprolol group 58 patients （60.4%）were tolerant target does （50mg/d）.All the patients hadn＇t special side effect.The common symptom was dizzinessNo significant changes of liver and kidney function, blood glucose, blood lipids, electrolytes, blood in the metoprolol group. The conclusion is based on the standard of medical treatment, metoprolol can improve left ventricular function, left ventricular remodeling in patients with chronic heart failure, metoprolol treatment of chronic heart failure treatment is safe and effective.