血管紧张素转换酶抑制剂及血管紧张素受体拮抗剂在CHF中应用观察.doc

血管紧张素转换酶抑制剂及血管紧张素受体拮抗剂在CHF中应用观察[摘要]目的探讨血管紧张素转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体拮抗剂（ARB），在充血性心力衰竭（CHF）中的作用。 方法 126例CHF的患者（男96例，女30 例，年龄58-86岁，平均76岁），在常规抗心衰治疗的基础上，随机将其分为2组：ACEI组61例，采用ACEI制剂贝那普利治疗；ARB组65例，采用ARB制剂氯沙坦治疗。分别观察2组在治疗1个月、3个月和6个月不同时期： 临床效果、心排血量（CO）、每搏输出量（SV）、射血分数（EF）和左室舒张末内径（LVDd）。 结果ACEI和ARB均可使 CHF患者临床症状及心功能改善，其临床有效率 2组无显著差异，而ARB组CO、SV和EF较ACEI组明显增加，LVDd也较ACEI组显著缩小，且不良反应少。结论ARB和ACEI治疗CHF均有明显效果,ARB较ACEI副作用少，病人易耐受。 [关键词]血管紧张素转换酶抑制剂； 血管紧张素Ⅱ受体拮抗剂； 充血性心力衰竭 [中图分类号] R73[文献标识码]A [文章编号] 1005-0515（2010）-12-018-01 Observation of angiotensin converting enzyme inhibitors And angiotensin receptor blockers in patients with CHF Shi YulanWu Guangtong Zhangxiahua ( Shanghai Armed Police HospitalShanghai201103) [Abstract]ObjectiveTo investigate the roles of angiotensin converting enzyme inhibitor (ACEI) and angiotensin Ⅱ receptor blocker (ARB)in the congestive heart failure (CHF) patients. Methods 126 cases of CHF patients ( 96 males, 30 females, aged 58-86 years, mean 76 years), based on the conventional anti-heart failure therapy, were randomly divided into 2 groups: ACEI group(n=61), using of ACEI benazepril formulation; ARB group(n=65), using of ARB agents losartan . The two groups were observed in the treatment of 1 month, 3 months and 6 months : the clinical effects, cardiac output (CO), stroke volume (SV), ejection fraction (EF) and left ventricular end diastolic diameter (LVDd). Results ACEI and ARB improved clinical symptoms and cardiac function in patients with CHF, there was no significant difference of clinical efficacy in two groups.But compared with ACEI group, in the ARB group, CO, SV and EF were significantly increased, LVDdwas significantly reduced, and the adverse reactions ware fewer. Conclusions In patients with CHF, treatments of ARB and ACEIhave significant effects, ARB has fewer side effects than ACEI, so it was well tolerated. [Keywords] angiotensinconvertingenzymeinhibitors; angiotensin Ⅱ receptorantagonist;congestiveheartfailure 充血性心力衰竭（conges