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目的观察卡托普利联用倍他乐克治疗慢性心力衰竭(CHF)的疗效、安全性并探讨其作用。方法120例CHF患者随机分为治疗组(60例)和对照组(60例);对照组给予强心、利尿和血管扩张剂常规治疗,病情稳定后给利尿剂最小剂量和地高辛维持量;治疗组在常规治疗心功能稳定后,在地高辛和利尿剂基础上加用小剂量卡托普利和倍他乐克,从6·25mg开始追加,逐周增加6·25mg,卡托普利用到25~50mg,3/d,倍他乐克用到25~50mg,2次/d。分别于3个月后进行随访。治疗前后对比心功能以及心脏超声心动图检查的左室收缩末期内径(LVS)、左室舒张末期内径(LVD)、左室舒张末期容量(LVEDV)、左室收缩末期容量(LVESV)、左室射血分数(LVEF)。运动耐量检测用6min步行实验。密切观察不良反应,每2周记录1次。结果两组治疗3个月~20个月随访期间,治疗组总有效率86·67%,对照组总有效率58·33%,差异有统计学意义(P<0·01)。治疗组在改善心功能方面显著优于对照组(P<0·05)。治疗组因心衰而再住院率和死亡率均低于对照组(P<0·05)。未见明显毒副作用。结论卡托普利并倍他乐克治疗CHF有较好疗效,可提高患者运动耐量,降低其再住院率和死亡率。
Objective To observe the efficacy and safety of captopril combined with Betaloc in the treatment of chronic heart failure (CHF). Methods One hundred and twenty patients with CHF were randomly divided into treatment group (60 cases) and control group (60 cases). The control group was given conventional therapy of cardiotomy, diuretic and vasodilator. After stable, the diuretic minimum dose and digoxin maintenance dose ; Treatment group in the conventional treatment of cardiac function was stable, plus digoxin and diuretics in addition to small doses of captopril and metoprolol, starting from 6 · 25mg added week by week 6.25mg, captopril Use to 25 ~ 50mg, 3 / d, metoprolol 25 ~ 50mg, 2 times / d. After 3 months were followed up. Left ventricular end-systolic diameter (LVS), left ventricular end diastolic dimension (LVD), left ventricular end diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), cardiac function and echocardiography were measured before and after treatment. Ejection fraction (LVEF). Exercise tolerance test with 6min walk test. Close observation of adverse reactions, recorded once every 2 weeks. Results During the follow-up period of 3 months to 20 months in both groups, the total effective rate was 86.67% in the treatment group and 58.33% in the control group, with significant difference (P <0.01). The treatment group was significantly better than the control group in improving cardiac function (P <0.05). The rehospitalization rate and mortality in the treatment group were lower than those in the control group due to heart failure (P <0.05). No obvious side effects. Conclusions Captopril and metoprolol have a good curative effect on CHF, which can improve exercise tolerance and reduce the rate of rehospitalization and mortality.