常规疗法加安体舒通与利尿剂长期规律间歇用药对慢性充血性心力衰竭疗效及安全性观察  

The Effect and Safety Issue of Regular Intermittent Combining Using Antisterone and Other Diuretics in Chronic Heart Failure Patients

作　　者：谢家冰[1] 黄锐[1] 谭宇峰[1] 

机构地区：[1]湖南省郴州市第三人民医院,423000

出　　处：《医学研究杂志》2009年第9期81-84,共4页Journal of Medical Research

摘　　要：目的观察在常规治疗慢性充血性心力衰竭(CHF)基础上联合有规律地间歇使用螺内酯与利尿剂,对慢性心力衰竭的疗效及安全性,并探讨一种给药方法,指导患者自觉、方便、安全用药。方法严重慢性充血性心力衰竭(CHFNYHAⅢ-Ⅳ级)患者,随机分成治疗组和对照组。对照组常规给予地高辛、卡托普利、硝酸异山犁酯,下肢水肿发生时临时给予呋塞米;治疗组在常规治疗基础上,长期规律间歇给予螺内酯(20mg、tid)和氢氯噻嗪(25mg,tid),两药每周连用3天,停服4天,水肿消退不理想时,加用呋塞米片(40mg、qid,每周2天),连续用药12个月。用药前后分别测定射血分数,心排出量,定期测定血清K+、Na+、BUN及Cr,并做血压及心电图监测。结果治疗组LVEF、CI及6min步行距离均较对照组明显改善(P<0.001),而血钾无明显变化(P>0.05)两组Cr、BUN增高无显著性差异(P>0.05),年住院时间及次数明显减少P<0.001)。治疗组男性乳腺增生2例,未观察到其余严重不良反应。结论常规治疗慢性充血性心力衰竭基础上联合长期规律间歇使用螺内酯及氢氯噻嗪(利尿效果欠佳时联合速尿),对无条件或不方便监测有关指标(如肾功能、血电解质、无法评价隐性水肿)的病人,更为合适。该治疗方法更适合社区和农村推广。Objective This study is to observe the effect and safety issue of regular intermittent combining using antisterone and other diuretics in chronic heart failure patients apart from conventional medications. The other aim is to investigate a method help patient take medication conveniently and safely. Methods Chronic heart failure patients were randomly divided into treatment group and control group. Digoxin, captopril and isorbid were given in both treatment and control group. Oral furosemide was given temporally when lower extremity edema was found. Antisterone （20mg tid） and Hydroehlorothiazide （25mg tid） were given in treatment group, continuing use for 3 days and suspend 4 days every week. Oral furosemide （40rag qd for 2days/week） was given when persistent edema. EF, CO, and serum K^＋ ,Na^＋ ,BUN and Cr were measured before and after treatment, as well as blood pressure and ECG. Results LVEF, CI and 6 minutes walking distance were improved statistically in treatment group （P 〈 0. 001 ）. Decreased annual length of hospital stay was found （P 〈 0. 001 ） while serum potassium concentration, Cr and BUN showed no significant difference （P 〉 0. 05 ）. 2 case of masculine mastoplasia were reported in treatment group and no other adverted effect was noticed. Conclusion Regular intermittent long term using antisterone and hydrochlorothiazide （combining furosemide when needed） is suitable for patient in whom kidney function and serum electrolytes monitoring are not available or not convenient. This method is suitable in community and rural area.

关 键 词：充血性心力衰竭 螺内酯 利尿剂 常规疗法 间歇规律用药 安全性 疗效 

分 类 号：R541.61[医药卫生—心血管疾病] R972.1[医药卫生—内科学]