收缩时间间期在观察Captopril对充血性心力衰竭疗效中的临床应用

Clinical Significance of Systolic Time Intervals for the Effects of Captopril on Patient with Heart Failure.

本文对20例射血前期/左心室射血时间>0.46明确诊断为充血性心力衰竭的病人进行Captopril疗效观察。对于伴有肾功能衰竭及血压低于90/60mmHg的未纳入本实验。利用随机双盲法将病人分为两组,实验组给予Captopril 12.5mgq8h,对照组给予安慰剂。两组均给予常规剂量的强心利尿药,分别在服药前及服药后0.5、2、6、24、48、72、68小时测STIs各指标,并对总电机械收缩时间、射血前期、左心室射血时间用心率进行校正,观察其系列动态变化。服药前及服药后三日利用二维及多普勒超声心动图测定左心室射血分数及心室内径缩短率。结果表明Captopril具有明显的降低血压(收缩压及舒张压),相对减慢心率作用,从而降低心肌耗氧量,服药前后对比差异显著(P<0.001)。能够使射血前期/左心室射血时间降低,射血前期缩短,总电机械收缩时间,左心室收缩时间延长,与对照组比较差异极其显著(P<0.001)。左心室射血分数及左室内径缩短率服药后均有明显增加,同服药前比较差异显著(P<0.05)。我们认为STIs、二维及多普勒超声心动图为观察Captopril疗效提供了可靠指标,具有操作简单、灵敏度高、稳定性好等优点,其中射血前期/左心室射血分数为最重要的指标,直接反映了心脏功能状态,为临床提供了定量的心功能指标。

The effects of Captopril on 20 patients diagnosed difinitely with congestive heart failure, whose PEP/LVET overnumbered 0.46 were observed and investigated. The patients who had following events were not included, systolic blood pressure lower than 90 mmHg, diastolic blood pressure lower than 60 mmHg, renal failure.The patients were randomly and double-blindly divided into two groups. One treated with oral Captopril 25 mg q. 8. h, the other with placebo. Cardiotonie and diuretic were given in both. (befor treatment stop using vasodilator at least one week). The measurements of BP HR, STIs were done at 0.5, 2, 6, 24, 48, 72, 168 hours and EF, ΔD% were done on the third day after ad ministration of Captopril or placebo. Among STIs, QS2, LVET, PEP were corrected for HR into indices. Our results revealed that Captopril has a great significant decrease in blood pressure both systolic and diastolic, relatively reduction in HR and increase in EF and ΔD%. These efforts reach their maximum at 2h, and persist during 6—8h. Captopril decreases PEF/LVET, shorting PEPT, prolonging QS2I and LVETI, There are significant differences between two groups. It is concluded that STIs and Doppler ultrasonic cardiogram are very useful to investigate the effect of Captopril, which has great advantages in simplification, sensitivity and reproducibility. Among STIs and Doppler ultrasonic cardiogram, PEP/LVET and EF are the most important indices. STIs and ultrasonic cardiogram can provide us with quantitative assessment of the status of the myocardiol performance.