高原地区联合应用美托洛尔、卡托普利治疗慢性充血性心力衰竭观察

[摘要] 目的 观察在高原地区应用美托洛尔联合卡托普利治疗慢性充血性心力衰竭患者（CHF）的疗效。 方法 选择心功能2～4级，左室增大、左室收缩末期容量增大及左室射血分数（LVEF）≤40%，有基础心脏病病史，有或无呼吸困难、乏力和体液潴留（水肿）等症状的患者40例，随机分为治疗组和对照组，对照组应用小剂量洋地黄、利尿剂、扩血管药物，治疗组在对照组基础上加用小剂量美托洛尔及卡托普利，6个月后进行比较。 结果 治疗组患者在左室舒张末内径（LVEDD）、左室射血分数（LVEF）、6 min步行距离试验（6-MWT）结果上差异均有统计学意义（P ＜ 0.05）。 结论 高原地区在传统治疗心力衰竭的基础上联合应用美托洛尔和卡托普利疗效显著。

[关键词] 高原地区；充血性心力衰竭；美托洛尔；卡托普利

[中图分类号] R972 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0092-02

Observation of metoprolol and captopril in treatment of chronic congestive heart failure in plateau regions

HE Sihai1 HE Chunhua2

1.Internal Medicine Department, People's Hospital of Guoluo State in Qinghai Province, Guoluo 814000, China; 2.Wasai Township Hospital of Jiuzhi County in Qinghai Province, Jiuzhi 624700, China

[Abstract] Objective To observe the efficacy of using metoprolol combined with captopril in treatment of chronic congestive heart failure (CHF) in plateau regions. Methods Forty patients were chosen as subjects. With heart function at grade (NYHA) 2-4, they were suffered from left ventricular enlargement, left ventricular end-systolic volume increase as well as LVEF≤40%, and had history of basic heart disease, with or without symptoms such as difficulty in breathing, lack of strength, and fluid retention (edema). The subjects were randomized into treatment group and control group. Small doses of digitalis, diuretic, and vascular dilation drugs were used on the control group, while small doses of metoprolol and captopril in addition to those given to the control group were administered on the treatment group. A comparison was made 6 months later. Results Patients in the treatment group showed significant differences in the results of left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), and 6-minute walking test (6-MWT) (P ＜ 0.05). Conclusion Combining metoprolol and captopril with traditional therapies on heart failure in plateau regions has significant efficacy.

[Key words] Plateau regions; Congestive heart failure; Metoprolol; Captopril

慢性充血性心力衰竭（CHF）的传统治疗方法以强心、利尿、扩血管为主，古老而临床积淀丰富的传统疗法目前还在本地区占有主导地位[1]。于高原地区实践应用《慢性收缩性心力衰竭治疗建议》[2]（以下简称《建议》）对于设备简陋、条件极其有限的我们是一种挑战。在传统方法治疗CHF疗效不甚满意时，笔者开始在海拔3 500～5 000 m地区探索实践这个《建议》。首先尝试在传统治疗基础上联合应用β受体阻滞剂+血管紧张素转换酶抑制剂即：联合美托洛尔、卡托普利，取得较好疗效，现报道如下：

1 资料与方法

1.1 一般资料

选择2007年4月～2010年4月40例住院CHF患者，其中，男性24例，女性16例，年龄41～73岁，平均（65.0±12.4）岁，病程1～15年；病因：高原性心脏病11例，高血压性心脏病9例，缺血性心脏病8例，先天性心脏病6例，风湿性心脏病5例，扩张性心肌病1例；根据纽约心脏病学会（NYHA）心功能分级心功能均在2～4级，左室增大、左室收缩末期容量增大及LVEF≤40%，有基础心脏病病史，有或无呼吸困难、乏力和体液潴留（水肿）等症状；所有患者血压均在85/55 mm Hg以上，心率在60/min以上，无Ⅱ度以上房室传导阻滞，无哮喘病史。将40例患者随机分为治疗组和对照组，治疗组22例，对照组18例，两组在性别、年龄、基础疾病构成、心功能分级上差异均无统计学意义。所有患者近3个月均未曾使用过β受体阻滞剂和ACEI类药物。