卡维地洛联合丹参酮ⅡA磺酸钠对慢性心力衰竭患者心室重构及能量代谢的影响

Effect of carvedilol combined with Tanshinone ⅡA sulfonate sodium on ventricular remodeling and energe metabolism in patients with chronic heart failure

目的探讨卡维地洛联合丹参酮ⅡA磺酸钠对慢性心力衰竭(CHF)患者心室重构及能量代谢的影响。方法将226例CHF患者随机分为对照组114例和观察组112例,两组患者均接受常规抗心力衰竭药物和卡维地洛治疗,观察组患者在此基础上加用丹参酮ⅡA磺酸钠,治疗8周后,比较两组患者的心功能[左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室射血分数(LVEF)]、心室重构指标[左心室厚壁厚度(LVPET)、左心室内径缩短率(LVFS)、室间隔收缩末期厚度(IVSS)、左心室质量指数(LVMI)]、能量代谢指标[左心室收缩末周向室壁应力(cESS)、心肌能量消耗(MEE)]、心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]及血流动力学指标[心脏指数(CI)、每搏输出量(SV)、肺毛细血管楔压(PCWP)]。结果治疗后两组患者LVEDd、LVESd、LVPWT、IVSS、LVMI、cESS、MEE、CK、CK-MB、LDH、CI、SV及PCWP均低于同组治疗前,LVEF和LVFS均高于同组治疗前(P<0.05)。治疗后观察组患者LVEDd、LVESd、LVPWT、IVSS、LVMI、cESS、MEE、CK、CK-MB、LDH、CI、SV及PCWP均低于对照组,LVEF和LVFS均高于对照组(P<0.001或P<0.05)。结论卡维地洛联合丹参酮ⅡA磺酸钠治疗可改善CHF患者的心肌酶谱和血流动力学,抑制心室重构和能量代谢进程,从而改善其心功能。

Objective To observe the effect of carvedilol combined with Tanshinone ⅡA sulfonate sodium on ventricular remodeling and energe metabolism in patients with chronic heart failure(CHF).Methods A total of 226 patients with CHF were randomly divided into control group(114 cases)and observation group(112 cases).Patients in the two groups received conventional anti-heart failure drugs and carvedilol.Patients in observation group were added sodium tanshinone ⅡA sulfonate on basis of above treatment.After 8 weeks of treatment,cardiac function[left ventricular end-diastolic dimension(LVEDd),left ventricular end-systolic dimension(LVESd),left ventricular ejection fraction(LVEF)],ventricular remodeling indexes[left ventricular posterior wall thickness(LVPWT),left ventricular fraction shortening(LVFS),inter-ventricular spetal end-systolic thickness(IVSS),left ventricular mass index(LVMI)],energe metabolism indexes[circumferential end-systolic wall stress(cESS),myocardial energy expenditure(MEE)],myocardial enzyme profile[creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH)]and hemorheology indexes[pulmonary capillary wedge pressure(PCWP),cardiac index(CI),stroke volume(SV)]were compared between the two groups.Results LVEDd,LVESd,LVPWT,IVSS,LVMI,cESS,MEE,CK,CK-MB,LDH,CI,SV and PCWPC after treatment were all significantly lower than those before treatment in the two groups,while LVEF and LVFS were significantly higher than those before treatment in the two groups(P<0.05).After treatment,LVEDd,LVESd,LVPWT,IVSS,LVMI,cESS,MEE,CK,CK-MB,LDH,CI,SV and PCWPC in observation group were all significantly lower than those in control group,while LVEF and LVFS were significantly higher than those in control group(P<0.001 or P<0.05).Conclusion Carvedilol combined with Tanshinone ⅡA sulfonate sodium can improve myocardial enzyme profile and hemorheology,suppress ventricular remodeling and energe metabolism,so as to improve cardiac function in patients with CHF.