卡维地洛和阿替洛尔治疗心衰疗效的观察

Comparision of the efficacy between carvedilol and atenolol in treating chronic congestive heart failure

目的 :比较卡维地洛和阿替洛尔对心衰的疗效。方法 :构建后负荷增高型心衰模型 ,卡维地洛和阿替洛尔干预 4周 ,观察心功能指标、心室重构情况。结果 :心衰组心功能恶化 ,卡维地洛和阿替洛尔降低心率 (HR)及平均动脉压 (MBP) ,改善心衰大鼠左室舒张末压 (LVEDP)和 -dp/dtmax(P <0 .0 1～ 0 .0 5 ) ;卡维地洛提高左室收缩压 (LVSP)和 +dp/dtmax(P <0 .0 1～ 0 .0 5 ) ;心衰组左室质量指数 (LVMI)和右室质量指数 (RVMI)增加 (P均 <0 .0 5 ) ,卡维地洛明显降低LVMI及RVMI(P均 <0 .0 5 ) ,与阿替洛尔有显著性差异 (P均 <0 .0 1)。结论 :阿替洛尔和卡维地洛均能改善心功能 ,前者改善心脏舒张功能 ,后者对收缩、舒张功能均有疗效。卡维地洛能抑制心室重构 ,有利于心衰的远期预后。

Objective:To compare the effects between carvedilol and atenolol in treating congestive heart failure of rat models,and to discuss the mechanism of carvedilol.Methods:8 weeks after partial ligating abdominal aorta,30 rats were randomly divided into 3 groups:heart failure group(n=10),carvedilol group(n=10) and atenolol group(n=10).Sham-operated group(n=10) were selected randomly as control.After 4 weeks of medical therapy,hemodynamic parameters and ventricular mass index were studied.Results:Compared with sham-operated group,all the hemodynamic parameters in heart failure group were deteriorated.In carvedilol and atenolol groups,heart rate(HR) and mean blood pressure(MBP) were decreased(P<0.01～0.05),and left ventricular end -diastolic pressure(LVEDP) and -dp/dt max improved significantly(P<0.05).Besides,left ventricular systolic pressure(LVSP) and +dp/dt max in carvedilol group were increased greatly(P<0.01～0.05)。In comparison with sham-operated group,left ventricular mass index(LVMI) and right ventricular mass index(RVMI) in heart failure group were increased by 19% and 30% respectively(P<0.01～0.05).Carvedilol decreased LVMI and RVMI,compared with heart failure group and atenolol group(P<0.01～0.05).Conclusion:Both carvedilol and atenolol can improve failing heart function.While atenolol mainly improves diastolic function,carvedilol has effect both on systolic and diastolic function,and it can protect against ventricular remodeling,which is of benefit for prognosis of heart failure.