靶剂量酒石酸美托洛尔对老年糖尿病并慢性心力衰竭患者心功能的影响

Effects of Metoprolol Tartrate on Heart Function in Senile Diabetes Patients with Chronic Heart Failure

目的：观察靶剂量酒石酸美托洛尔对老年糖尿病并慢性心力衰竭患者心功能的影响。方法：104例老年糖尿病并慢性心力衰竭患者按随机数字表法均分为对照组和观察组。对照组患者给予吸氧、胰岛素或口服降糖药、血管紧张素转换酶抑制剂、利尿药、硝酸酯类药物等常规治疗;观察组患者在对照组治疗的基础上给予酒石酸美托洛尔片,初始剂量6.25 mg,口服,bid,视病情改善情况每14 d增加1次剂量,前3次每次增加6.25 mg,此后每次增加6.25~12.5 mg,至靶剂量100 mg,口服,bid。两组患者疗程均为6个月。观察两组患者治疗前后左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、左室射血分数（LVEF）、6 min步行距离、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、急性心力衰竭加重率、病死率及不良反应发生情况。结果：治疗前两组患者LVESD、LVEDD、LVEF、6 min步行距离比较,差异无统计学意义（P〉0.05）。治疗后两组患者LVESD、LVEDD显著低于同组治疗前,且观察组低于对照组,LVEF、6 min步行距离显著高于同组治疗前,且观察组高于对照组,差异有统计学意义（P〈0.05）。两组患者治疗前后FBG、HbA1c比较,差异无统计学意义（P〉0.05）。两组患者急性心力衰竭加重率、病死率比较,差异均无统计学意义（P〉0.05）。观察组患者不良反应发生率显著高于对照组,差异有统计学意义（P〈0.05）。结论：靶剂量酒石酸美托洛尔可有效改善老年糖尿病并慢性心力衰竭患者的心功能,延缓心肌重构,虽然不良反应发生率较高,但患者均可耐受。

OBJECTIVE：To observe the effects of metoprolol on heart function in senile diabetes patients with chronic heart failure. METHODS：104 senile diabetes patients with chronic heart failure were randomly divided into control group and observation group. The control group was given routine treatment as oxygen inhalation,insulin,oral administration of antidiabetic drugs,ACEI,diuretic,nitric ether. On the basis of control group,the observation group was additionally given Metoprolol tartrate tablet6.25 mg orally,bid;increasing drug dosage every 14 days,increasing by 6.25 mg each time,at first 3 times,and then increasing by 6.25-12.5 mg each time to target dose 100 mg,bid. Treatment course of 2 groups lasted for 6 months. LVESD,LVEDD,LVED,6 min walking distance,fasting blood glucose,glycosylated hemoglobin,rate of acute heart failure aggravation,mortality and ADR were observed in 2 groups before and after treatment. RESULTS：LVESD,LVEDD,LVED and 6 min walking distance of 2 groups had no statistical significance before treatment（P〉0.05）. LVESD and LVEDD of 2 groups after treatment were significantly lower than before,and those of observation group was lower than those of control group;LVED and 6 min walking distance of 2 groups after treatment were significantly higher than before,and those of observation group was higher than those of control group;there was statistical significance（P〈0.05）. The fasting blood glucose and glycosylated hemoglobin of 2 groups had no statistical significance before and after treatment（P〉0.05）. The mortality and rate of acute heart failure aggravation had no statistical significance between 2 groups（P〉0.05）. The incidence of ADR in observation group was significantly higher than in control group;there was statistical significance（P〈0.05）. CONCLUSIONS：Target dose of metoprolol can effectively improve heart function of the elderly diabetic patients with chronic heart failure and delay myocardium reconstruction. Although high incidence of ADR,the drug can be tolerated.