老年慢性充血性心力衰竭急性加重期患者美托洛尔剂量调整的临床研究  

The prognostic analysis of dose adjustment for beta blockers in the acute exacerbation of chronic congestive heart failure in the elderly

作　　者：陈春泉[1] 王敏[1] 李庆丰[1] 翁小雁 陈积党 

机构地区：[1]浙江省平阳县人民医院心内科,325400

出　　处：《中国基层医药》2015年第23期3539-3542,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的评价美托洛尔剂量调整对老年人慢性充血性心力衰竭急性加重期的临床疗效和对预后的影响，为临床治疗方案的制定提供参考依据。方法选取慢性充血性心力衰竭（CHF）急性加重患者76例，在接受美托洛尔配合其他合理治疗的基础上，按随机数字表法分为阻滞剂剂量减半组（40例）和全停组（36例）；调整3个月后，观察患者剂量调整后的临床症状，用无创血流动力学检测仪测量心指数（CI）、左心做功（LCW）、心输出量（CO）等指标变化，用免疫放射分析法分析血浆B型钠尿肽（BNP）水平。结果按照前述方案给予治疗后72h密切关注病情，剂量减半组病情进展13例，好转27例；全停组进展加例，好转16例。两组病情好转率差异有统计学意义（x2=4．09，P〈O．05）；美托洛尔调整后两组上述指标比较，差异均有统计学意义（X2=4．52，P〈0．05），减半组NYHA分级、cO、CI、LCW较调整之前变化不明显，全停组NYHA变化明显，ⅡL／Ⅳ病情发展病例数增加5例和3例，C0、CI、LCW分别减小约25％、35％、30％。美托洛尔调整后，美托洛尔减半组BNP（321．8±97．6）mg／L，明显低于美托洛尔全停组的（422．3±139．4）mg／L，差异有统计学意义（t：3．94，P〈0．05）。结论在接受美托洛尔配合其他合理治疗的基础上，CHF患者急性加重期减半应用比停用预后较好，且安全性高。Objective To evaluate the effects and the prognosis of beta receptor blocker （metoprolol） dose adjustment of senile patients with chronic congestive heart failure （CHF） of acute exacerbation, and to provide reference for clinical treatment. Methods 76 cases with chronic CHF in acute exacerbation who treated with beta blockers and other reasonable treatment were randomly divided into half dose group （40 cases） and full stop group （36 cases）. After adjusted for 3 months, the clinical symptoms were observed, noninvasive hemodynamic machine was used to detect cardiac index （CI） ,left cardiac work （LCW）, cardiac output （CO） and changes of other indicators. Immunoradiometric analysis was used to detect plasma type B natriuretic peptide （BNP）. Results 72h after treatment,in the half dose group, the progression of the disease in 13 cases, improved in 27 cases, in the full stop group,progression in 20 cases, improvement in 16 cases, the difference was statistically significant （X2 = 4.09, P 〈 0.05）. Before the adjustment of metoprolol, the index of the two groups had statistically significant difference （X2 = 4. 52 ,P〈0. 05 ）. Compared with pretreatment, the changes of NYHA classification, Co, CI, LCW of the half dose group were not obvious, and he change of NYHA of the full stop group was obvious,, ⅡL/Ⅳ the progression of the disease the number of cases increased in 5 cases and 3 cases, Co, Ci, LCW were reduced by about 25% , 35% and 30%. After the adjustment of metoprolol, BNP of the half dose group was （321. 8±97.6）mg,/L, which was significantly lower than （422.3±139.4）mg/L of the full stop group, the difference was statistically significant （t = 3.94,P 〈 0.05）. Condusion In the patients with beta blockers combined with other reasonable treatment, CHF patients with acute exacerbation of the beta blockers than the discontinuation of the prognosis, and the safety is high.

关 键 词：心力衰竭 充血性 美托洛尔 

分 类 号：R541.61[医药卫生—心血管疾病]