低剂量螺内酯治疗严重心力衰竭的临床疗效观察  

Clinical effect of low-dose spironolactone on severe heart failure

作　　者：段鲁勤[1] 曹育真[1] 

机构地区：[1]泰山医学院第一教学医院急救中心,山东泰安271000

出　　处：《泰山医学院学报》2002年第4期397-399,共3页Journal of Taishan Medical College

摘　　要：目的　观察低剂量螺内酯对严重心力衰竭的临床效果及安全性。方法　对 81例严重心衰患者 (NYHA分级Ⅲ～Ⅳ心脏射血分数≤ 3 5 % ) ,进行双盲随机试验。在常规抗心衰治疗的基础上 ,治疗组加服 2 0mg/d螺内酯治疗 ,对照组接受安慰剂治疗共进行 12个月。监测血清肌酐、尿素氮、钾、血压和脉搏的变化 ,Holter监测室性心律失常的发生率 ,最后评价死亡率。结果　对照组高钾血症的发生率为 5 % ,治疗组高钾血症发生率只有 9 8% ,治疗组动脉血压比对照组降低 ,而血肌酐、尿素氮水平并无明显变化 ,Holter结果示 1年前后治疗组每小时室性早搏发生率和 2 4h非持续性心动过速的发作要均有明显减少 (P <0 0 0 0 1) ,1年对照组死亡 18例 ( 45 % ) ,治疗组死亡11例 ( 2 6 8% ) ,死亡率下降 3 8% (P <0 0 5 )。结论 :低剂量螺内酯 ( 2 0mg/d)对严重心衰疗效肯定。Objective: To study the curative effect of low-dose spironolactone on severe heart failure. Methods: In a randomized double-blind study, 81 patients with severe heart failure (NYHA class Ⅲ-Ⅳ and a left ventricular ejection fraction less than 35%) were enrolled and treated by anti-heart failure. In twelve months, the treatment group received 20 mg of spironolactone daily, while the control group did placebo. Serum levels of creatinine, urea nitrogen, potassium, changes of pulse and blood pressure were measured periodically. Holter monitoring was used to assess the ventricular arhythmia. And finally, the mortality of the patients was calculated. Results: The incidences of hyperkalemia in the control and the treatment group were 5% and 9.8% respectively. Compared with those in the control group, systolic and diastolic arterial pressures decreased and serum levels of creatinine and urea nitrogen did not significantly change in the treatment group. Holter monitoring analysis indicated that in one year there was an apparently decrease in the hourly frequency of ventricular premature complexes (P<0.0001) and episodes of nonsustained ventricular tachycardia. In a year 18(45%) and 11 (26.8%) cases died in the control group and spironolactone treatment group, there was 38% percent reduction in the risk of death ratio among them(P<0.05). Conclusion: Low-dose spironolactone (20 mg/d) can be used in the treatment for patients with severe heart failure, which has minimal adverse effects and is effective in reversing the reconstruction of the heart, and thus reduces the mortality of the patients with severe heart failure.

关 键 词：低剂量 螺内酯 治疗 心力衰竭 临床 疗效观察 

分 类 号：R541.6[医药卫生—心血管疾病] R972.[医药卫生—内科学]