美托洛尔联合复方氢氯噻嗪治疗老年重症心力衰竭临床疗效及血流动力学的改善作用

Clinical Effect and Hemodynamics Improvement of Metoprolol Combined with Compound Hydrochlorothiazide in the Treatment of Elderly Patients with Severe Heart Failure

目的探讨美托洛尔联合复方氢氯噻嗪治疗老年重症心力衰竭临床疗效及对血流动力学的影响。方法将2012年1月至2014年12月解放军第九七医院收治的106例老年重症心力衰竭患者按照随机数字表法分为观察组和对照组,各53例。对照组口服酒石酸美托洛尔片起始剂量12.5 mg/次,2次/d,单次最大剂量≤50 mg。观察组在对照组基础上口服厄贝沙坦氢氯噻嗪,每日1片,治疗3个月为1个疗程。比较两组患者临床疗效和治疗前后心脏结构情况、血流动力学变化情况;并记录两组患者不良反应发生率。结果观察组总有效率显著高于对照组[98.1%(52/53)比83.0%(44/53),P<0.05];两组患者治疗后左心室射血分数(LVEF)均显著升高,其中观察组LVEF显著高于对照组[(34.8±9.7)%比(31.6±8.4)%,P<0.05];而治疗前后及两组间左心室舒张期末径(LVEDD)、左心室收缩期末径(LVESD)、左心室每搏量(LVSV)比较差异均无统计学意义(P>0.05)。两组患者治疗后肺动脉楔压(PAWP)、肺动脉平均压(PAMP)、右心房压(RAP)、体循环血管阻力(SVR)均显著降低,心排血量(CO)、心脏指数(CI)显著升高,与治疗前比较差异均有统计学意义(P<0.05);其中治疗后观察组PAWP、PAMP、RAP、SVR显著低于对照组[(14.6±3.1)mm Hg(1 mm Hg=0.133 k Pa)比(18.4±3.7)mm Hg,(23.8±6.7)mm Hg比(27.2±8.7)mm Hg,(6.5±1.1)mm Hg比(6.8±0.8)mm Hg,(125.9±11.0)k Pa·s/L比(142.2±9.6)k Pa·s/L],CO、CI显著高于对照组[(5.3±1.1)L/min比(4.4±1.2)L/min,(2.9±0.7)L/(min·m2)比(2.5±0.7)L/(min·m2)],差异有统计学意义(P<0.05)。治疗期间,观察组总不良反应发生率与对照组比较差异无统计学意义(P>0.05)。结论美托洛尔联合厄贝沙坦氢氯噻嗪治疗老年重症心力衰竭,其临床疗效好,对血流动力学改善作用明显,且不良反应发生率低,值得临床推广。

Objective To explore the clinical effect and hemodynamics improvement of metoprolol combined with compound hydrochlorothiazide in the treatment of elderly patients with severe heart failure.Methods A total of 106 elderly severe heart failure patients treated in PLA Ninety-seventh Hospital from Jan. 2012 to Dec. 2014 were divided into an observation group of 53 cases and a control group of 53 case according to the random number table method. The control group was treated with metoprolol tartrate tablets,with the starting dose of 12. 5 mg / times,2 times / d,maximum single dose ≤50 mg; the observation group based on the control group’s regimen was added irbesartan hydrochlorothiazide tablets 1 pill / d,3 months as 1course. The clinical effect and cardiac structure,hemodynamic changes before and after treatment of the two groups were compared,andthe adverse reaction rates were recorded. Results The total efficacy of the observation group was significantly higher than the control group[98. 1%( 52 /53) vs 83. 0%( 44 /53),P <0. 05]. After treatment left ventricular ejection fraction( LVEF) of both groups were significantly higher,and the observation group was significantly higher than the control group[( 34. 8 ± 9. 7) % vs( 31. 6 ± 8. 4) %,P < 0. 05 ],while left ventricular end-diastolic diameter( LEVDD),left ventricular end-systolic dimension( LVESD),left ventricular stroke volume( LVSV) of the two groups had no statistically significant difference( P > 0. 05). After treatment pulmonary arterial wedge pressure( PAWP),pulmonary arterial mean pressure( PAMP),right atrial pressure( RAP),systemic vascular resistance( SVR) of both groups were significantly decreased,cardiac output( CO),cardiac index( CI) were significantly increased,compared with before treatment the differences were statistically significant( P < 0. 05); PAWP,PAMP,RAP,SVR of the observation group were significantly lower than the control group [( 14. 6 ± 3. 1) mm Hg vs( 18. 4 ± 3. 7) mm Hg,( 23. 8 ± 6. 7) mm Hg vs( 27. 2 ± 8. 7) mm Hg,( 6. 5 ± 1. 1) mm Hg vs( 6. 8 ± 0. 8) mm Hg,( 125. 9 ±11. 0) k Pa·s / L vs( 142. 2 ± 9. 6) k Pa·s / L],while CO,CI was significantly higher than the control group[( 5. 3 ±1. 1) L/min vs( 4. 4 ±1. 2) L/min,( 2. 9 ±0. 7) L/( min·m2) vs( 2. 5 ± 0. 7) L/( min·m2) ]( P <0. 05). The total adverse reaction rate of the two groups had no statistically significant differences( P >0. 05). Conclusion Metoprolol combined with irbesartan hydrochlorothiazide in the treatment of elderly patients with severe heart failure,has high clinical efficacy,with obvious hemodynamics improvement and low incidence of adverse reactions,thus is worthy of clinical promotion.