琥珀酸美托洛尔缓释片和参芪扶正注射液治疗慢性心力衰竭的临床疗效比较

Comparative Study for Clinical Effect on Chronic Heart Failure Between Metoprolol Succinate Sustained- release Tablet and Shenqifuzheng Injection

目的比较琥珀酸美托洛尔缓释片和参芪扶正注射液治疗慢性心力衰竭(CHF)的临床疗效。方法选取广元市第二人民医院2012年12月—2014年12月收治的CHF患者120例,随机分为A组、B组和对照组,每组40例。对照组患者给予血管紧张素转换酶抑制剂、硝酸酯类、阿托伐他汀等常规治疗,A组患者在对照组基础上联合琥珀酸美托洛尔缓释片治疗,B组患者在对照组基础上联合参芪扶正注射液治疗;3组患者均治疗12周。比较3组患者治疗前后心功能指标〔左心室射血分数(LVEF)、每搏输出量(SV)、心脏指数(CI)、心输出量(CO)〕、6分钟步行距离(6MWT)及血浆脑钠肽(BNP)水平,观察两组患者治疗期间不良反应发生情况。结果 3组患者治疗前LVEF、SV、CI、CO比较,差异无统计学意义(P>0.05);A组、B组患者治疗后LVEF、SV、CI、CO均高于对照组(P<0.05);A组患者治疗后LVEF、CI均低于B组,SV、CO均高于B组(P<0.05)。3组患者治疗前6MWT、血浆BNP水平比较,差异无统计学意义(P>0.05);A组、B组患者治疗后6MWT长于对照组,血浆BNP水平低于对照组(P<0.05);A组患者治疗后6MWT短于对照组,血浆BNP水平低于B组(P<0.05)。治疗期间A组2例患者出现头晕,2例患者出现窦性心动过缓;B组3例患者出现头晕,1例患者出现血压偏低等症状。结论琥珀酸美托洛尔缓释片与参芪扶正注射液治疗CHF的临床疗效均较佳,且不增加患者的不良反应,临床需结合患者实际情况选择用药。

Objective To compare the clinical effect on chronic heart failure between metoprolol succinate sustained-release tablet and shenqifuzheng injection. Methods A total of 120 patients with chronic heart failure were selected in the Second People＇s Hospital of Guangyuan from December 2012 to December 2014,and they were randomly divided into A group,B group and control group,each of 40 cases. Patients of control group received conventional treatment, including angiotensin converting enzyme inhibitor,nitrates,atorvastatin and so on,patients of A group received extra metoprolol succinate sustained-release tablet based on conventional treatment, while patients of B group received extra shenqifuzheng injection based on conventional treatment; all of the three groups continuously treated for 12 weeks. Cardiac function index（ including LVEF,SV,CI and CO）,6- minute walk distance and plasma BNP level were compared among the three groups before and after treatment,and incidence of adverse reactions during treatment was observed. Results No statistically significant differences of LVEF,SV,CI or CO was found between the two groups before treatment（ P〈0. 05）; after treatment,LVEF,SV,CI and CO of A group,of B group were statistically significantly higher than those of control group（ P〈0. 05）, LVEF and CI of A group were statistically significantly lower than those of B group,while SV and CO of A group were statistically significantly higher than those of B group（ P〈0. 05）. No statistically significant differences of 6- minute walk distance or plasma BNP level was found between the two groups before treatment（ P〈0. 05）; after treatment,6- minute walk distance of A group,of B group was statistically significantly longer than that of control group, respectively, plasma BNP level of A group, of B group was statistically significantly lower than that of control group,respectively（ P〈0. 05）,6- minute walk distance of A group was statistically significantly shorter than that of B group,plasma BNP level of A group was statistically significantly lower than that of B group（ P〈0. 05）. Of A group,2 cases occurred dizziness,2 cases occurred sinus bradycardia; of B group,3 cases occurred dizziness, 1 case occurred hypotension. Conclusion Both metoprolol succinate sustained- release tablet and shenqifuzheng injection have better clinical effect in treating chronic heart failure, without increasing the risk of adverse reactions,clinician should make reasonable choice based on the patients＇ practical situation.