依贝沙坦及卡托普利联合治疗充血性心力衰竭疗效.docVIP

依贝沙坦及卡托普利联合治疗充血性心力衰竭疗效 　 作者：周泉，胡振玉， 吴大方， 张同利， 钟筱兰 【关键词】 充血性心力衰竭 Captopril combined with irbesartan in treating patients with congestive heart failure 　　【Abstract】 AIM: To evaluate the effects of captopril combined with irbesartan in treating patients with congestive heart failure (CHF). METHODS: One hundred and twenty patients, who had unsatisfactory results by conventional treatment of digitalis, diuretics and βblocking agent, were randomly divided into group A and group B. Group A (n=60) was given captopril 50-150 mg/d and irbesartan 75-300 mg/d and Group B (n=60) was given captopril 50-150 mg/d. The changes of NYHA class, biochemistry, liver function, renal function, electrocardiogram and echocardiography were observed. RESULTS: After 12 weeks treatment, left atrium （LA） diameter, left ventricular end diastolic diameter（LVDD）, left ventricular end systolic diameter（LVSD） and left ventricular ejection fraction (EF) were improved significantly in both groups (Plt;0.01). LVDD, LVSD EF and NYHA class were more significant in group A than those in group B (Plt;0.05). There was a significant difference of adverse reaction before and after the treatment between the 2 groups (Plt;0.05). CONCLUSION: Irbesartan combined with captopril is more effective than captopril alone in the treatment of patients with CHF. 　　【Keywords】 irbesartan； captopril；congestive heart failure；drug therapy; combination 　　【摘要】 目的：研究依贝沙坦与卡托普利联合治疗充血性心力衰竭（CHF）与单用卡托普利的疗效. 方法：CHF患者120例在应用利尿剂、β受体阻断剂、洋地黄治疗的基础上，分为A组(n=60)口服依贝沙坦75~300 mg/d，卡托普利75~150 mg/d；B组(n=60)口服卡托普利50~150 mg/d. 治疗前后进行心功能NYHA分级评估，行血生化、肝肾功能、心电图、超声心动图检查. 结果：治疗12 wk后两组左房内径(LA)，左室舒张末内径(LVDD)，左室收缩末内径(LVSD)，左室射血分数(EF)均有改善（Plt;0.01）. A组LVDD，LVSD，EF及心功能改善总有效率比B组更显著（Plt;0.05）. 两组治疗后不良反应发生率有明显差异（Plt;0.05）. 结论：依贝沙坦与卡托普利联合治疗CHF优于单用卡托普利. 　　【关键词】 依贝沙坦；卡托普利；充血性心力衰竭；药物疗法;联合 　　0引言 　　肾素血管紧张素系统（RAS）的血管紧张素转换酶抑制剂（ACEI）已成为ACC/AHA首位推荐治疗充血性心力衰竭(congestive heart failure, CHF)的药物. 作用于RAS的血管紧张素Ⅱ受体拮抗剂（ARB）对CHF患者同样可产生有益的血液动力学变化，改善心功能，提高患者的生存率，且具有更良好的依存性［1］. 为了对RAS