应用大剂量西拉普利治疗慢性心力衰竭的安全性及疗效观察

Safety and clinical efficacy of large-dosage cilazapril in chronic heart failure treatment

目的 评价大剂量西拉普利在慢性心力衰竭 (CHF)患者中应用的安全性及疗效。方法 10 3例CHF患者 (男 83例 ,女 2 0例 ) ,平均年龄 5 9岁 ,心功能Ⅱ Ⅳ级 ,左室射血分数 (LVEF) 35 %。从小剂量开始使用 ,只要能耐受 ,尽可能递增到 5～ 7 5mg d ,治疗中严密监测各项相关指标。结果 平均随访时间近 2 0周 ,随访期间死亡 5例 ,其中心性死亡 4例 ,非心性死亡 1例 ,2例因心力衰竭加重而再次住院。治疗后心功能和 6min步行距离较治疗前明显改善 [( 2 0 4± 0 6 6 )比 ( 3 0 5± 0 6 5 )和( 310 2 9± 180 14)m比 ( 2 0 0 87± 175 97)m ,P <0 0 0 1],超声心动图检查示左室舒张末径 (LVEDD)和收缩末径 (LVESD)减小 [( 6 1 17± 9 90 )mm比 ( 6 3 86± 10 2 0 )mm和 ( 47 2 4± 11 0 2 )mm比 ( 5 1 4 9±11 0 7)mm ,P <0 0 0 1],LVEF明显增加 [( 34 82± 8 14) %比 ( 43 78± 10 37) % ,P <0 0 0 1]。本组患者治疗后血压略有下降 ,血钾略升高 ,但均在正常范围内 ,血肌酐无明显变化。非缺血性心脏病组与缺血性心脏病组比较 ,LVESD变化率和LVEF变化率差异有显著性 [( 9 13± 12 72 ) %比 ( 4 38±10 39) % ,( 39 6 9± 42 11) %比 ( 2 0 97± 2 2 84) % ,P <0 0 5和 0 0 1]。

Objective To evaluate safety and clinical efficacy of large-dosage cilazapril in treatment of chronic heart failure(CHF). Methods One-hundred and three patients with CHF (male 83,female 20),average age of 59 years old and average EF 35%,underwent cilazapril therapy with dosage titrating from 1.25 mg to 5-7.5 mg per day if they were tolerated. Results During 20 weeks follow-up,5 patients died, among them 4 due to cardiac cause,and 2 admitted again due to aggravated heart failure.After treatment, NYHA classification and 6-minute walk distance were improved markedly [(2.04±0.66) vs (3.05±0.65);(310.29±180.14)m vs (200.87±175.97)m, P<0.001,respectively]. Left ventricular end-diastolic diameter(LVEDD) and left ventricular end-systolic diameter(LVESD)measured by echocardiography reduced [(61.17±9.90)mm vs (63.86±10.20)mm;(47.24±11.02)mm vs (51.49±11.07) mm,P<0.001,respectively],left ventricular eject fraction(LVEF)increased[(34.82±8.14)% vs (43.78±10.37)%,P<0.001].The blood pressure decreased(P<0.001) and serum potassium increased(P<0.01) at the end of follow-up,but all in the normal range.Serum creatinine had no change.The change of LVESD and LVEF in the non-ischemic heart disease was greater than that in ischemic heart disease[(9.13±12.72)% vs (4.38±10.39)%;(39.69±42.11)% vs (20.97±22.84)%,P<0.05 and P<0.01,respectively]. Conclusion Application of large-dosage cilazapril to the treatment of chronic heart failure is safe. After treatment,patient′s exercise capability and cardiac function improve,LVEF increases significantly.