比索洛尔改善充血性心衰心功能及心肌重塑的疗效观察

Effects of bisoprolol on heart function and myocardial remodeling in patients with congestive heart failure

目的 观察比索洛尔 (bisoprolol)对充血性心衰心功能及心肌重塑的临床疗效 .方法 2 12例患者随机分为比索洛尔组和常规药物组 ,比索洛尔剂量起始量 0 .6 2 5 mg～1.2 5 0 mg,1次· d- 1 ,逐渐增加至最大剂量为 2 .5 mg～ 5 .0mg,1次· d- 1 .观察心功能、临床疗效、左室舒张末内径(L VEDD)、左室收缩末内径 (L VESD)、射血分数 (EF)、舒张早期 E峰流速 /舒张晚期 A峰流速 (VE/ VA) .结果 比索洛尔组与常规药物组比较 ,比索洛尔治疗 3m o后有效者(87.7% )高于常规药物组 (6 6 .0 % ) ,P <0 .0 5 ;冠心病(87.9% )和扩张型心肌病心衰 (91.9% )疗效明显好于常规药物组 (分别为 6 6 .7% ,6 7.4 % ) ;治疗 6 mo后重度心衰者疗效(90 .0 % )明显好于常规药物组 (6 5 .4 % ,P <0 .0 5 ) .治疗后比索洛尔组 L VESD[(44 .8± 3.9) m m vs(48.8± 4 .6 ) mm],EF[(40 .7± 7.5 ) % vs (35 .7± 5 .2 ) % ]优于常规药物组 (P<0 .0 1) ;L VEDD,VE/ VA也较治疗前有明显改善 .结论 比索洛尔改善充血性心力衰竭临床症状 ,促进心脏收缩、舒张功能恢复 ,部分逆转心肌重塑 .

AIM To evaluate the clinical effect of bisoprololon heart function and myocardial remodeling in congestive heart failure (CHF). METHODS 212 patients with chronic heart failure of various etiologies and the left ventricular ejection fraction of <40% randomly entered the bisoprolol and control groups. Bisoprolol was administered orally in the initial dose of 0.625~1.25 mg·d -1 and then 2.5~5 mg was instilled daily. The heart function (NYHA) and parameters in hemodynamics (LVEDD, LVESD, EF and VE/VA) were observed. RESULTS 3 months later, the heart function more favorably improved in the bisoprolol group (87.7%) than in the control group (66.0%, P <0.05). Compared with the control group, CHF due to coronary heart disease (87.9% to 66.7%, P <0.05) and idiopathic dilated cardiomyopathy (91.9% to 67.4%, P <0.01) improved significantly in the bisoprolol group. 6 months later, the heart function of patients with serious CHF also more favorably improved in the bisoprolol group (90%) than in the control group (65.4%, P <0.05). LVESD was shortened obviously in the bisoprolol group as compared with the controls [(44.8± 3.9) vs (48.8±4.6) mm, P <0.01], and EF was enhanced in the bisoprolol group as compared with the controls [(40.7±7.5)% vs (35.7±5.2)%, P <0.01]. LVEDD and VE/VA got better than those of pre therapy ( P <0.01). CONCLUSION Bisoprolol may relieve symptoms, increase cardiac systolic and diastolic functions, and partially regress myocardial remodeling.