卡维地洛治疗2型糖尿病并发急性心肌梗死后心功能衰竭患者的疗效及安全性观察

Efficacy and safety of carvedilol in the treatment of type 2 diabetes mellitus patients with acute myocardial infarction

目的:探讨卡维地洛治疗2型糖尿病并发急性心肌梗死后心力衰竭的临床疗效及用药安全性。方法:将本院118例2型糖尿病并发急性心肌梗死后心力衰竭患者按就诊顺序随机分为两组,每组为59例,均采取常规药物治疗,而观察组在此基础上加用卡维地洛治疗,比较两组治疗前后心功能各项指标、血糖水平及心脏事件和不良反应发生情况。结果:研究组治疗的总有效率明显高于对照组,统计学具有统计学意义(P<0.05);两组治疗后心功能各项指标均较治疗前明显改善,差异具有统计学意义(P<0.05);而观察组治疗后左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)较对照组明显减少,左室射血分数(LVEF)和心脏指数(CI)较对照组明显增加,差异具有统计学意义(P<0.05);两组治疗后FPG较治疗前明显降低,差异具有统计学意义(P<0.05);两组均未出现重度房室传导阻滞、皮疹、水肿或肾功能恶化等病例;且观察组随访期间心脏事件总发生率低于对照组,差异具有统计学意义(P<0.05)。结论:卡维地洛治疗2型糖尿病并发急性心肌梗死后心力衰竭疗效确切,可明显改善患者心功能,且对体内糖代谢无明显影响,并能降低心脏事件的发生率,具有较好的安全性,值得临床推广和应用。

Objective： To explore the clinical efficacy and safety of carvedilol in the treatment of type 2 diabetes mellitus patients with acute myocardial infarction. Methods： A total of 118 patients who had type 2 diabetes mellitus complicated with heart failure after acute myocardial infarction were randomly divided into two groups, with 59 cases in each group. Both groups were given conventional drug treatment. Based on the use of carvedilol treatment, patients in observation group were given carvedilol treatment. The cardiac function indexes, blood glucose levels and heart event and the occurrence of adverse reactions of two groups before and after treatment were compared. Results： The total effectiveness of observation group was significantly higher than that of control group（P〈0.05）. All indexes of cardiac function of two groups were significantly improved after treatment （P〈0.05）. LVEDD and LVESD of the observation group were significantly decreased, the LVEF and CI increased significantly compared with the control group （P〈0.05） ; FPG of two groups after treatment were significantly decreased compared with those before treatment （P〈0.05）, while FINS and HOMA-IR compared with before treatment showed no significant difference （P〉0.05） ; the two groups had no severe atrioventrieular Block, rash, swelling or deterioration of renal function were observed during the follow-up period. The total incidence of cardiac events of observation group was 11.86%, significantly lower than 23.73% in the control group （P〈0.05）. Oonclusions： Carvedilol has significant curative effect in the treatment of type 2 diabetes mellitus complicated with heart failure after acute myocardial infarction. It can improve heart function of patients, and has no significant effect on glucose metabolism, and can reduce theincidence of cardiac event. It is safe, and worthy the clinical promotion and application.