比索洛尔和美托洛尔治疗慢性心力衰竭合并慢性阻塞性肺疾病疗效比较  

Differences between Bisoprolol and Metoprolol in patients with chronic heart failure and chronic obstructive pulmonary disease

作　　者：孔繁宇[1] 邓家强[1] 刘军明[1] 廖志山 富蓉[1] 魏峥[1] 黄健安[1] 邓俊明 范志勇[1] 张琴[1] 

机构地区：[1]广东省佛山市南海区中医院心内科,510080

出　　处：《中国现代医药杂志》2015年第1期34-36,共3页Modern Medicine Journal of China

摘　　要：目的探讨比索洛尔和美托洛尔在慢性心力衰竭(CHF)合并慢性阻塞性肺疾病(COPD)患者的疗效差异。方法随机抽取63例患者,分别患有轻到中度CHF和中到重度COPD,在治疗前和治疗中进行肺功能试验、12导联心电图和N端脑利钠肽检查。结果 31例患者达到两种药物的目标剂量,19例在治疗中出现不良反应(比索洛尔19%,美托洛尔42%,P=0.045);8例患者因不良反应而停药(比索洛尔组:2例因低血压,1例因心动过缓;美托洛尔组:2例因低血压,3例分别因哮喘、呼吸困难和水肿)。比索洛尔组比美托洛尔组患者的第1秒用力呼气量显著增加(比索洛尔组:1 561±414ml vs 1 698±519ml,P=0.046;美托洛尔组:1 704±484ml vs 1 734±548ml,P=0.441)。两种药物均降低了心率(比索洛尔组:75±14 vs 68±10,P=0.007;美托洛尔组:78±14 vs 72±12,P=0.016)。然而均未对N端脑利钠肽产生影响。结论β受体阻滞剂常引起不良反应,只有49%的患者可耐受目标剂量。研究表明,比索洛尔比美托洛尔能够较好改善肺功能状态且引起的不良反应少。Objective To explore effect of Bisoprolol and Metoprolol in patients with chronic heart failure （CHF） and chronic obstructive pulmonary disease （COPD）. Methods Randomized 63 elderly patients with mild to moderate CHF and moderate to severe COPD. Pulmonary function testing,12-lead electrocardiogram and N-terminal pro brain natriuretic peptide were measured before and during therapy. Results 31 patients reached the target dose of two drugs, 19 cases of adverse re-actions during the treatment （Bisoprolol：19%, Metoprolol：42%,P=0.045）. 8 cases of withdrawal due to adverse events （Biso-prolol： 2 cases due to hypotension,1 case due to bradycardia; Metoprolol： 2 cases due to hypotension, 3 cases respectively for wheezing, dyspnoea, and oedema）. Forced expiratory volume in 1st second significantly increased in Bisoprolol （1 561±414ml vs 1 698±519ml, P=0.046; Metoprolol：1 704±484ml vs 1 734±548ml, P=0.441）. Both agents reduced heart rate （Bisoprolol：75±14 vs 68±10, P=0.007; Metoprolol：78±14 vs 72±12, P=0.016） and had no effect on N-terminal pro brain natriuretic pep-tide. Conclusion Beta blockers frequently caused adverse events, and thus 49% of patients could tolerate the target dose. Bisoprolol induced demonstrable improvement in pulmonary function and caused less adverse events.

关 键 词：慢性心力衰竭 慢性阻塞性肺疾病 比索洛尔 美托洛尔 

分 类 号：R541.6[医药卫生—心血管疾病] R563.9[医药卫生—内科学]