老年充血性心力衰竭对卡维地洛的耐受性研究.DOCVIP

临床医学论文-老年充血性心力衰竭对卡维地洛的耐受性研究 ?????????? 作者：杨东伟 李纲 韩学华 李玉东 【摘要】? 　　目的：研究卡维地洛治疗慢性老年充血性心力衰竭(CHF)的临床疗效及耐受性。方法：60例老年(65岁) CHF患者随机分为2组。对照组：采用常规治疗方法(ACEI/ARb、利尿剂、地戈辛)；治疗组：在对照组治疗的基础上加用卡维地洛，治疗4月。治疗前后检查超声心动图，测定左心室射血分数(LVEF)，并行6分钟步行试验，记录心率、血压。结果：治疗组显示心功能改善、LVEF、6min步行距离、心率均有显著改善(P0.01)，对照组的LVEF、6min步行距离较治疗前虽有明显改善(P0.05)，但与治疗组相比仍有显著差异(P0.01)。结论：在常规治疗老年CHF患者的基础上加用目标剂量的卡维地洛,对CHF患者是安全有效的。 【关键词】? 充血性心力衰竭 卡维地洛 超声心动描记术 　　The tolerance study of elder patients with congestive heart failure to carvedilol ???? 【Abstract】Objection: To study the clinic efficacy and tolerance in the treatment of congestive heart failure(CHF) in elder patients. Methods: Sixty elderly patients( ＞65y)with CHF were divided? randomly into control group t and reatment group. The first group was treated with basic treatment(ACEI/Arb,diuretic and digoxin)and cavedilol added to the late group except the basic treatment for 4 months. Left ventricular ejection fraction(LVEF), 6-minute walk test were assessed and blood pressure(BP)、heart rate(HR) were recorded before and after 4 months treatment respectively. Results: LVEF、6-minute walk test、HR were significantly improved in treatment group through the treatment(p0.01). Although LVEF、6-minute walk test also improved in control group after the treatment (p0.05) ,they? have obvious difference with treatment group. Conclusion: On the basic treatment for elder patients with CHF, adding cavedilol is safety and efficacy.? ??? 【Key words】Carvedilol; Congestive heart failure ;Echocardiography ??? 充血性心力衰竭 (CHF) 是多种心血管疾病后期常见的临床表现，其病程较长，死亡率高。近年来研究发现β受体阻滞可改善症状、减低死亡率。但对老年患者的研究较少，本文旨在探讨第三代肾上腺素β受体阻滞剂卡维地洛对老年CHF患者的临床疗效、耐受性和安全性。 ??? 1? 对象与方法 ??? 1.1? 临床资料? 2003年8月～2004年8月在我院住院的老年CHF患者(＞65岁)60例，超声心动图均示LVEF＜0.45；男38例，女22例；年龄65～91岁，平均(78±18)岁；NYHA心功能分级Ⅱ～Ⅳ级。缺血性心脏病34例，高血压性心脏病18例，扩张型心肌病8例。随机分为对照组：男20例，女10例；年龄65～82岁，平均(76±16)岁，采用常规治疗方法(ACEI/ARb、利尿剂、地戈辛)。治疗组：男18例，女12例；年龄65～91岁,平均(80±20)岁,在对照组治疗的基础上加用卡维地洛。两组患者在年龄、性别、心功能分级、病史、血压、心率、左室射血分数均无显著差异，保证两组有可比性。排除条件：①静息状态下收缩压＜90mmHg；②静息状态下心率＜60次/分；③Ⅱ度以上房