三靶点疗法治疗高血压心力衰竭患者的临床研究

Clinical Study on Three-Target Therapy in Treatment of Hypertension in Patients with Heart Failure

目的探讨醛固酮拮抗剂螺内酯、血管紧张素受体拮抗剂缬沙坦及β受体阻滞剂美托洛尔三靶点疗法治疗高血压心力衰竭患者的临床疗效。方法选取2011年5月至2012年5月在广州市海珠区沙园街社区卫生服务中心就诊的高血压性心脏病慢性心功能不全患者64例,依据用药不同分为对照组和观察组各32例,对照组给予缬沙坦80~320 mg/d,美托洛尔初始剂量6.25 mg,每日2次;观察组在对照组的基础上加用醛固酮拮抗剂螺内酯,每次20 mg,每日2次。治疗8周后比较临床疗效、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、醛固酮的血浆水平及不良反应,应用SPSS 18.0软件进行数据统计分析。结果观察组总有效率为87.5%,对照组为62.5%,观察组的疗效显著高于对照组(Z=3.27,P=0.001);两组治疗前及治疗后分别自身比较,LVEDD、LVEF、醛固酮水平差异均有统计学意义(P<0.05),两组治疗后组间相互比较LVEDD、LVEF差异无统计学意义(P>0.05),治疗后观察组醛固酮水平低于对照组[(276.78±105.25)pmol/L vs(342.23±118.72)pmol/L],差异有统计学意义(P<0.05),即治疗后醛固酮水平显著降低,观察组下降幅度比对照组显著。结论三靶点疗法治疗高血压心力衰竭患者的疗效肯定,用药简单、合理,安全,值得推广。

Objective To investigate the clinical value of three-target therapy with spironolactone, valsartan and metoprolol in treatment of hypertension in patients with heart failure. Methods A total of 64 cases of patients with hypertension combined with heart failure from May 2011 to May 2012 in Community Health Service Center of Haizhuqu District Sand Park Street Guangzhou were divided in control and observa- tion groups by random number method. 32 cases of patients in control group were treated with valsartan （80-320 rag/d, bid） and metoprolol（ initial dosage 6.25 rag/d, bid）, and the observation group were treated with spironolactone（20 mg/d,bid） on the basis of control group treatment. The clinical curative effect and left ventricular end diastolic diameter（ LVEDD）, left ventricular ejection fraction （LVEF） , plasma levels of aldosterone and adverse reactions were compared between the two groups after 8 weeks of treatmetn. SPSS 18.0 software was adopted for the statistics analysis. Results The total effective rate of the observation group was 87.5% ,of the control group was 62.5% （Z =3.27 ,P =0. 001 ）. The changes of LVEDD,LVEF,plasma levels of aldosterone were significant before and after treatment in each group respectively （ P 〈 0.05 ）. But there was no significant difference of LVEDD, LVEF after treatment between the two groups （ P 〉 0.05 ）. While the plasma levels of aldostenme of the observation group was significantly lower than the control group [ （276.78 ± 105.25 ） pmol/L vs （342.23 ± 118.72） pmol/L]（ P 〈 0. 05 ） , i. e. aldosterone level was more significantly decreased ＇after treatment than the control group. Conclusion Three-target therapy in the treatment of hypertension in patients with heart failure is eft^ctive ,simple ,reasonable,safe,and worth popularization.