赖诺普利联合螺内酯治疗舒张性心力衰竭的疗效观察  

Effects of Lisinopril and Spironolactone on patients with diastolic heart failure

作　　者：范耀东[1] 丁娜[1] 阚建英[1] 赵连余 

机构地区：[1]天津市第二医院心内科,300141 [2]天津市第二医院超声心动图室,300141

出　　处：《新医学》2010年第6期365-368,共4页Journal of New Medicine

摘　　要：目的:观察赖诺普利联合螺内酯治疗舒张性心力衰竭(DHF)的临床疗效。方法:将88例DHF患者,依据治疗方案分为治疗组(45例)和对照组(43例),对照组给予基础治疗(包括硝酸酯类、钙拮抗药、排钾利尿药、β受体阻断药),治疗组在此基础上口服赖诺普利(5～10mg/d)和螺内酯(20mg/d),比较治疗前后两组脑钠肽、舒张早期二尖瓣血流速度峰值(E)、二尖瓣舒张环早期运动速度(Ea)和舒张晚期运动速度(Aa)、Ea/Aa、E/Ea、肺静脉舒张晚期逆行血流峰值(PVF-A)、左心房内径(LAD)及6min步行试验(6MWT)等,随访1年。结果:与治疗前比较,治疗后两组患者6MWT增加,E峰、PVF-A、E/Ea、脑钠肽降低,Ea及Ea/Aa升高(P<0.01或0.05),治疗组治疗后LAD缩小(P<0.05)。两组治疗后比较,除LAD、Ea无明显差异外,其余指标治疗组改善均优于对照组(P<0.01)。治疗组心功能改善总有效率达93%,明显高于对照组(P<0.01)。结论:基础治疗联合赖诺普利、螺内酯能更明显改善DHF患者的舒张功能,提高患者运动耐量,改善临床症状。Objective： To observe the effects of Lisinopril and Spironolactone on patients with diastolic heart failure （DHF）. Methods： Eighty-eight patients with DHF were divided into control group （45 cases） and treatment group （43 cases）. The control group received conventional therapy （including nitrate esters, calcium antagonists, potassium-removing and diuretic drugs, and β-adrenergic receptor blockers）, while the treatment group was treated with additional Lisinopril （5 -10 mg/d） and Spironolactone （20 mg/d）. The two groups were compared in aspects of plasma brain natriuretic peptide, peak early diastolic mitral inflow velocity （E）, early diastolic mitral annular velocity （Ea） and late diastolic mitral annular velocity （Aa）, Ea/Aa ratio, E/Ea ratio, peak late diastolic retrograde velocity of pulmonary venous flow （ PVF-A）, the diameter of the left atrium （LAD） and 6-minute walk test （6MWT）, with a 12-month follow-up. Results： Compared with those before treatment, walking distances measured by 6MWT of both groups were extended after treatment. Meanwhile, the values of E, PVF-A, E/ Ea and the level of brain natriuretic peptide were reduced, while the values of Ea and Ea/Aa were increased （P 〈 0. 01 or 0. 05 ）. Also, LAD of the treatment group were found to narrow down （ P 〈 0. 05 ）. After treatment, improvements in all the aforementioned aspects, except LAD and Ea, were more apparent in the treatment group （P 〈0. 01 ）. The effective rate of the treatment group amounted to 93%, which was remarkably different from that of the control group （P 〈0. 01 ）. Conclusion： Combined treatment with Lisinopril and Spironolactone was more effective to improve heart diastolic function than the conventional therapy in treating patients with DHF, with extension of movement tolerance and reduction of clinical symptoms.

关 键 词：心力衰竭 舒张性 赖诺普利 螺内酯 左心室射血分数 

分 类 号：R541.6[医药卫生—心血管疾病]