卡维地洛与美托洛尔治疗心力衰竭的疗效对比观察  

Comparison therapy effect of carvedilol and motoprolol in patients with congestive heart failure

作　　者：高薇[1] 李玉宏[1] 曲鹏[2] 

机构地区：[1]辽宁医学院附属第一医院心内科,辽宁锦州121001 [2]大连医科大学附属第二医院心内科

出　　处：《临床心血管病杂志》2007年第12期903-906,共4页Journal of Clinical Cardiology

摘　　要：目的:比较卡维地洛与美托洛尔治疗充血性心力衰竭(CHF)的疗效及对神经激素、细胞因子的影响。方法:选择CHF患者120例,随机分3组。A组为对照组:予以血管扩张剂、利尿剂、地高辛等常规心力衰竭治疗。B、C组在上述治疗基础上分别予以美托洛尔50mg,bid、卡维地洛25mg,bid口服,维持该剂量至6个月。用药前后分别观察左室射血分数(LVEF)、每搏输血量(SV)、短轴缩短率(FS)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、相对室壁厚度(RWT)及醛固酮(ALD)、肿瘤坏死因子-α(TNF-α)、内皮素(ET)、心钠素(ANP)等指标变化情况。结果:6个月后B组及C组LVEDD、LVESD缩小,RWT增厚,LVEF、FS、SV明显提高,而ALD、ET、TNFα、ANP水平明显降低,与治疗前及A组比较均差异有统计学意义。B、C组再入院率及病死率均明显低于A组,同时C组LVEF改善优于B组。结论:美托洛尔、卡维地洛均可明显降低CHF患者神经激素、细胞因子的水平,逆转心室重塑,改善心脏功能。卡维地洛疗效及耐受性略优于美托洛尔。Objective:To investigate the influence of carvedilol and motoprolol on cardiac function,levels of neurohormone and cytokines in patients with congestive heart failure(CHF),and to compare the difference of therapy effect between selective β-receptor blocker and nonselective β-receptor blocker.Method:One hundred twenty patients with CHF were divided into three groups by random.A was the control group treated with nitroglycerin,Diuretics,digoxin.B and C group were treated in the same way with motoprolol or carvedilol was added.In B group dose of motoprolol was slowly titrated up to the target 50 mg twice daily,in C group dose of carvedilol to the 25 mg twice daily,and all patients were treated with this dose for six months.Left ventricular ejection fraction(LVEF),stroke volume(SV),fractions shortening(FS),left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),relative wall thickness(RWT)and variety of aldosterone(ALD),endothelin(ET),tumor necrosis factor(TNFα),atrial natriuretic polyeptide(ANP)of patients were observed before and after therapy.Result:After treatment with motoprolol 50 mg or carvedilol 25 mg twice per day,plasma ALD,ET,TNFα,ANP levels were declined significantly,LVEDD,LVESD decreased,RWT increased and LVEF,FS,SV were raised obviously.Mortality and morbidity in group B and C were lower obviously than that in group A.Conclusion:Motoprolol and carvedilol can decrease the level of neurohormone,cytokines and ventricular remodeling,improved cardiac function,and treatment effect of carvedilol is better than that of metoprolol.

关 键 词：心力衰竭 充血性 美托洛尔 卡维地洛 心室功能 

分 类 号：R541.6[医药卫生—心血管疾病]