慢性心力衰竭急性失代偿患者口服小剂量β受体阻滞剂的血流动力学变化  

Hemodynamic change in patients with acutely decompensated chronic heart failure undergoing low-dose of oral administration of beta-blocker

作　　者：陈雀敏[1] 张健[1] 韦丙奇[1] 刘冰[1] 黄燕[1] 安涛[1] 苏文亭[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院心血管病研究所急重症中心心衰病房,北京市100037

出　　处：《中华老年多器官疾病杂志》2010年第3期245-248,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家十一五支撑项目(2006BA101A04)资助

摘　　要：目的探索口服β受体阻滞剂对慢性心力衰竭急性失代偿患者的血流动力学的影响。方法将应用Swan-Ganz导管监测治疗的慢性心力衰竭急性失代偿患者按照是否在使用β受体阻滞剂分成β受体阻滞剂组和无β受体阻滞剂组,对比分析院内死亡率、住院时间、住监护室时间及血流动力学监测指标。结果共152例患者,男127例,女25例,β受体阻滞剂组131例,无β受体阻滞剂组21例,β受体阻滞剂组与无β受体阻滞剂组的性别、年龄、NYHA心功能分级、心率、血压、病因、伴随疾病、用药情况等基线资料基本一致。两组间β受体阻滞剂的使用不会增加院内死亡率(P=0.14),延长住院时间(P=0.54)及住监护室时间(P=0.716)。对肺毛细血管楔压、心指数、肺血管阻力指数、体循环阻力指数等的影响无统计学差异,能明显降低肺动脉收缩压(P=0.018)、肺动脉舒张压(P=0.031)、平均肺动脉压(P=0.042)、肺血管阻力(P=0.044)、中心静脉压(P=0.000)。结论口服低剂量的β受体阻滞剂不会恶化慢性心力衰竭急性失代偿患者血流动力学状态,在心率较快,血压可耐受的情况下可谨慎地使用。Objective To evaluate the hemodynamic effect of oral administration of beta-blocker in patients with acutely decompensated chronic heart failure. Methods Acutely decompensated chronic heart failure patients who had Swan-Ganz catheter were divided into beta-blocker group and no-beta-blocker group according to whether beta-blocker was used. The data,including hospital mortality,length of hospital stay,length of intensive care unit stay and hemodynamic parameters,were compared between the two groups. Results Totally 152 patients （127 males,25 females） were included. There were 131 patients in beta-blocker group and 21 patients in no-beta-blocker group. There was no significant difference between two groups in baseline data,such as sex,age,NYHA functional class,heart rate,blood pressure,etiology of heart failure,medical history and medications,and so on. Oral administration of beta-blockers did not prolong total length of hospital stay （P=0.54）,length of intensive care unit stay（P=0.716）or increase hospital mortality（P=0.14）. Beta-blockers decreased pulmonary artery systolic pressure（P=0.018）,pulmonary artery diastolic pressure（P=0.031）,mean pulmonary arterial pressure（P=0.042）,pulmonary vascular resistance （P=0.044） and central venous pressure（P=0.000）. Conclusion Oral administration of low dose of beta-blockers does not exacerbate the hemodynamic parameters in patients with acutely decompensated chronic heart failure,which may not be forbidden in case with tolerable blood pressure and faster heart rate.

关 键 词：心力衰竭 肾上腺素β受体拮抗剂 医院死亡率 

分 类 号：R541.6[医药卫生—心血管疾病]