依那普利、螺内酯与比索洛尔三药联合治疗风湿性心脏病合并慢性心力衰竭的效果观察

Effect of combination of enalapril,spironolactone and bisoprolol on chronic heart failure complicated by rheumatic heart disease

目的探讨依那普利、螺内酯比及索洛尔三药联合方案对风湿性心脏病(RHD)合并慢性心力衰竭(CHF)的疗效。方法抽取2018年4月至2020年4月于德州市人民医院进行治疗的120例RHD合并CHF患者作为研究对象,采用双盲法分为两组,每组60例。对照组采用常规治疗及依那普利、螺内酯两药联合治疗,观察组在对照组治疗基础上加用比索洛尔。比较两组治疗3个月后的临床效果、心律及心率情况,以及心功能情况,包括左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF),比较两组药物不良反应发生情况。结果治疗3个月后,观察组总有效率(90.00%,54/60)高于对照组(45/60,75.00%),差异有统计学意义(P<0.05)。两组患者心律失常发生情况比较差异未见统计学意义(P>0.05)。观察组24 h平均心率低于对照组(P<0.05)。观察组LVESD、LVEDD值低于对照组,LVEF值高于对照组(P<0.05)。两组用药期间不良反应发生率比较差异未见统计学意义(P>0.05)。结论依那普利、螺内酯与比索洛尔三药联合方案治疗RHD合并CHF可进一步提高临床疗效,提高心功能,且用药相对安全。

Objective To investigate the therapeutic effect of combination of enalapril,spironolactone and bisoprolol on rheumatic heart disease(RHD)complicated by chronic heart failure(CHF).Methods A total of 120 patients with RHD and CHF who were treated in Dezhou People’s Hospital from April 2018 to April 2020 were selected as study subjects.The patients were divided into two groups by double-blind method,with 60 cases in each group.The control group received conventional treatment,and enalapril combined with spironolactone;and the observation group received bisoprolol additionally,based on the treatment of control group.The clinical effect,hear rhythm,heart rate,cardiac function assessed by left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),and drug adverse reactions were compared between the two groups after 3 months of treatment.Results After 3 months of treatment,the total effective rate of the observation group was 90.00%(54/60),significantly higher than the 75.00%(45/60)of the control group(P<0.05).There was no significant difference in incidence of arrhythmia between the two groups(P>0.05).The 24 h mean heart rate of the observation group was lower than that of the control group(P<0.05).LVESD and LVEDD values of the observation group were lower than those of the control group,and the LVEF values were higher,compared with those of the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions The combined regimen of enalapril,spironolactone and bisoprolol for the treatment of RHD with CHF can further improve the clinical efficacy,improve cardiac function,and is relatively safe.