老年心力衰竭合并慢性阻塞性肺疾病患者应用琥珀酸美托洛尔缓释片2年随访

2-year Follow-up of the Effect of Metoprolol Succinate Sustained Release Tablets on the Elderly with Chronic Heart Failure Combined with Chronic Obstructive Pulmonary Disease

目的探讨高选择性β受体阻滞剂在慢性心力衰竭(chronic heart failure,CHF)合并慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者中长期应用的耐受性和有效性。方法 2015年7月—2016年9月,选择≥65岁的CHF合并COPD患者94例,分为观察组(n=64)和对照组(n=30)。观察组在接受常规CHF治疗基础上,从小剂量开始逐步增加琥珀酸美托洛尔缓释片剂量,直到静息心率达标;对照组不给予或予小剂量琥珀酸美托洛尔缓释片后不根据心率调整剂量,余治疗同观察组。随访2组患者24个月内的心率、血压、超声心动图、再住院频次、肺功能和全因死亡情况。结果 2组再入院率(50.8%vs 81.3%,P=0.004)和年再入院人次(0.48次/人年vs 1次/人年,P=0.002)比较,差异均有统计学意义。与对照组相比,观察组死亡率有所下降,但差异无统计学意义;2组患者的死亡原因无统计学差异。对存活患者的分析显示,2组患者的左心室射血分数(left ventricular ejection fraction,LVEF)在6个月时均提高,差异有统计学意义(P=0.000),观察组在24个月时LVEF呈进一步提高趋势,与基线相比差异有统计学意义(P=0.000),而对照组无进一步改善。与基线时比较,2组6个月时第1秒用力呼气容积/用力肺活量有所改善,差异均有统计学意义(P=0.000),但24个月时差异均无统计学意义。结论长期以目标剂量琥珀酸美托洛尔缓释片治疗合并COPD的CHF患者,可以改善心功能,降低再入院率和再入院次数,且对肺功能无明显不良影响。

Objective To determine the tolerance and effectiveness of long-term application of highly-selectiveβreceptor blockers on the elderly with chronic heart failure(CHF)combined with chronic obstructive pulmonary disease(COPD).Methods 94 elderly≥65 years old with CHF combined with COPD were selected during the period from July,2015 to Sept.,2016 and divided into 2 groups:observation group(n=64)and control group(n=30);besides the routine treatment of CHF,the elderly in observation group were given metoprolol succinate sustained release tablets,from small dosage gradually to the target dosage for normal resting heart rate while the elderly in control group were given no metoprolol succinate sustained or just small dosage;follow-up for both groups lasted for 24 months and heart rate,blood pressure,echocardiogram,re-hospitalization frequency,pulmonary function and all-cause mortality were observed.Results The difference in re-hospitalization rate or re-hospitalization times per person between the 2 groups were statistically significant(50.8%vs 81.3%,P=0.004;0.48 time/per person a year vs once/per person a year,P=0.002);the mortality in observation group was lower than that in control group with no statistical difference(P=0.34)and no statistical difference was found in the causes of death between the 2 groups(P=0.63);the analysis made to the survivors showed that LVEF of the elderly in both groups considerably increased at the 6th month(P=0.000)and LVEF of the elderly kept further increasing at the 24th month,statistically different from that of the base line(P=0.000)while no further improvement was found in control group;FEV1/FVC of the elderly in both groups were much more improved at the 6th month than that at base line with statistical difference(P=0.000)while the difference at the 24th month was of no statistical significance.Conclusions Long-term application of metoprolol succinate sustained release tablets at a target dosage to the CHF elderly combined with COPD can improve the cardiac function and reduce the rate and times of re-hospitalization with no obvious side effect on pulmonary function.