螺内酯对老年人重度心力衰竭的疗效

Efficacy of spironolactone in the treatment of aged patients with congestive heart failure

目的 探讨小剂量醛固酮拮抗剂螺内酯治疗老年人重度慢性充血性心力衰竭 (congestiveheartfailure ,CHF)的疗效和安全性。方法 采用随机、单盲、安慰剂对照、平行组试验。入选老年重度CHF患者 1 52例 ,随机分为螺内酯组 (A组 )和对照组 (B组 ) ,均予标准三联抗心衰治疗 ,A组联用螺内酯 (2 0～ 40mg/d) ,B组联用安慰剂。治疗前和治疗后 2周、4周、8周分别进行心功能 (NYHA)分级评估 ,心电图、超声心动图、血常规、生化等检查 ,并进行对照。结果 治疗 8周后A、B两组心功能分级、无创心排量指标均显著改善 (P <0 .0 5) ;与B组比较 ,A组改善更显著(P <0 .0 5)。无肝、肾功能损害及血脂、血糖升高 ,未见高血钾症 ,毒副作用少。结论 应用螺内酯治疗老年人重度CHF疗效肯定、安全性好、值得推广。

Objective To evaluate the clinical therapeutic efficacy and safety of spironolactone in aged patients with chronic congestive heart failure(CHF). Methods The multicentral,randomized, single blind, placebo controlled, parallel group trial was conducted in 2 hospitals. Aged patients with CHF(NYHA class IV) consisted of 152 cases were randomized into group A and B. The patients in both groups received standard treatment(ACE I, diurectics and digitals). In addition, group A was given spironolactone(20-40 mg/d), group B was given placebo. The heart function (by NYHA), electrocardiogram, echocardiography, blood routine and biochemistry were performed before and after the treatment of 2 weeks, 4 weeks and 8 weeks. Results Eight weeks after treatment, NYHA class, LVEF, SV, CO and CI improved significantly in both groups (P< 0.05 ), but more significantly in group A than those in group B (P< 0.05 ). Nobody got hyperpotassemia. The side effects were rare. Conclusion Use of spironolactone is absolutely reliable and safe for aged patients with CHF and worth popularizing.