美托洛尔治疗老年高血压相关左室射血分数正常的左心衰竭的可行性研究  

Feasibility of Metoprolol on Left Ventricular Failure with Deserved Left Ventricular Ejection Fraction in Senile Patients with Hypertension

作　　者：吴正蓉[1] 钟华[1] 戚龙[1] 

机构地区：[1]成都医学院第一附属医院,四川省成都市610000

出　　处：《实用心脑肺血管病杂志》2015年第2期17-21,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨美托洛尔治疗高血压相关左室射血分数(LVEF)正常的左心衰竭的可行性。方法选择成都医学院第一附属医院2011年3月—2013年8月收治的LVEF正常的左心衰竭患者50例(年龄>60岁),根据合并高血压情况分为高血压组29例和非高血压组21例。两组患者均在标准抗心力衰竭治疗基础上采用美托洛尔治疗。观察两组患者治疗前后收缩压、舒张压、平均动脉压、心率、率压积、中心静脉压、LVEF、左室舒张末期内径(LVEDD)、室间隔厚度、心功能分级,美托洛尔用量及不良反应情况。结果高血压组患者治疗前收缩压、舒张压、平均动脉压、率压积高于非高血压组,LVEDD小于非高血压组(P<0.05);高血压组患者治疗后收缩压、平均动脉压、心率、率压积高于非高血压组(P<0.05)。两组患者治疗后收缩压、舒张压、平均动脉压、心率、率压积、中心静脉压均低于治疗前,高血压组患者治疗后LVEF低于治疗前、LVEDD大于治疗前,非高血压组患者治疗后LVEDD小于治疗前(P<0.05)。两组患者治疗前心功能分级均为Ⅳ级;高血压组患者治疗后心功能分级Ⅰ级15例,Ⅱ级10例,Ⅲ级2例,Ⅳ级2例;非高血压组患者治疗后心功能分级Ⅰ级9例,Ⅱ级7例,Ⅲ级4例,Ⅳ级1例,两组患者治疗后心功能分级比较,差异无统计学意义(P>0.05)。高血压组患者美托洛尔用量为(86.21±34.29)mg/d,大于非高血压组的(63.69±41.82)mg/d(P<0.05)。高血压组患者不良反应发生率为31.0%,非高血压组为33.3%,差异无统计学意义(P>0.05)。结论美托洛尔治疗老年高血压相关LVEF正常的左心衰竭是可行的,有助于降低患者心肌耗氧量及交感神经活性,改善患者心功能,但所需剂量较大。Objective To investigate the feasibility of metoprolol on left ventricular failure（ LVF） with deserved left ventricular ejection fraction（ LVEF） in senile patients with hypertension. Methods From March 2011 to August 2013,a total of 50 senile LVF patients with deserved LVEF（ aged over 60 years old） were selected in the the First Affiliated Hospital of Chengdu Medical College,and they were divided into groups A（ with hypertension,n = 29） and B（ without hypertension,n= 21） according to the incidence of hypertension. Both groups were given standard heart failure therapy and metoprolol. SBP,SDP,MAP, HR, HR × SBP, CVP, LVEF, LVEDD, IVST, cardiac functional grading before and after treatment,metoprolol dosage and incidence of adverse reactions were compared between the two groups. Results SBP,SDP,MAP,HR× SBP of A group were higher than those of B group before treatment,while LVEDD was lower（ P〈0. 05）; SBP,MAP,HR,HR × SBP of A group were higher than those of B group after treatment（ P〈0. 05）. SBP,SDP,MAP,HR,HR × SBP,CVP of both groups after treatment were lower than before treatment,and LVEF of A group after treatment was lower than before treatment,LVEDD of A group after treatment was higher than before treatment,while LVEDD of B group was lower than before treatment（ P〈0. 05）. Cardiac functional grading of both groups was Ⅳ before treatment; after treatment of A group,15 cases grading at Ⅰ,10 cases grading at Ⅱ,2 cases grading at Ⅲ,2 cases grading at Ⅳ,while that of B group was 9,7,4,1,respectively,the difference was not statistically significantly different（ P〈0. 05）. The metoprolol dosage of A group was（ 86. 21 ± 34. 29） mg/d,was significantly higher than that of B group of（ 86. 21 ± 34. 29） mg/d. The incidence of adverse reactions of A group was 31. 0%,that of B group was 33. 3%,the difference was not statistically significantly different（ P〈0. 05）. Conclusion Metoprolol is feasible in the treatment of LVF with deserved LVEF in senile patient

关 键 词：心力衰竭 左 高血压 美托洛尔 心力衰竭 老年人 射血分数 

分 类 号：R541[医药卫生—心血管疾病]