氯沙坦钾和盐酸苯那普利对老年高血压患者左室肥厚和左室功能的作用  

Effect of Losartan K and Benazepril HCL on cardiac hypertrophy and left ventricular function in elderly patients with essential hypertension

作　　者：陆惠华[1] 孟超[1] 邬亦贤[1] 方宁远[1] 宋秀兰[1] 石迪明[1] 沈莉蕴[1] 张怡[1] 

机构地区：[1]上海第二医科大学附属仁济医院老年病科,200127

出　　处：《中华老年医学杂志》2003年第9期526-529,共4页Chinese Journal of Geriatrics

摘　　要：目的　应用多普勒超声心动图评价氯沙坦钾和盐酸苯那普利对老年原发性高血压患者左室肥厚 (LVH)的逆转作用和应用心肌作功指数 (MPI)评价药物对左室功能的改善作用。　方法　6 9例患者随机分组 ,分别选用氯沙坦钾 5 0mg(38例 )或盐酸苯那普利 10mg(31例 )每天 1次口服 ,疗程 2 4周。治疗前、后测定左室室壁厚度和收缩舒张功能 ,并根据等容舒张期和等容收缩期之和与射血期的比值计算MPI。　结果　LVH患者经盐酸苯那普利治疗后左室重量指数降低 ,由治疗前的(14 6 9± 15 1) g/m2 降至治疗后的 (130 1± 17 5 ) g/m2 ,P <0 0 5。两组射血分数均在正常范围 ,药物治疗后二尖瓣舒张早期E峰加速度均显著增加〔分别为 (5 89 6± 176 9)cm/s2 和 (74 0 8± 2 4 2 7)cm/s2 ,(6 6 4 7± 2 5 7 5 )cm/s2 和 (85 3 6± 2 6 9 1)cm/s2 〕 ,均为P <0 0 1。氯沙坦钾组患者治疗后等容舒张时间和射血时间改善 ,分别为 (12 1 8± 2 4 1)ms和 (95 5± 2 4 6 )ms、(2 5 8 8± 38 7)ms和 (2 95 5± 37 5 )ms,均为P <0 0 1,MPI由 0 6 1± 0 13降至 0 4 5± 0 12 (P <0 0 1)。　结论　盐酸苯那普利对左室肥厚有逆转作用 ,并能改善心肌的松弛性 ;氯沙坦钾能更有效改善老年高血压患者的左室功能。Objective To observe the efficacy of losartan K and benazepril HCL on cardiac hypertrophy by Doppler echocardiography and evaluate left ventricular function by using the Doppler-derived myocardial performance index (MPI) in elderly patients with essential hypertension. Methods Sixty-nine elderly patients from geriatric department with mild to moderate hypertension were divided into two groups with antihypertensive treatment of 50 mg losartan K or Benazepril HCL (oral, once a day) for 24 weeks. Doppler echocardiographic data were measured before and after treatment. The MPI was calculated as follows: MPI=(IRT+ICT)/ET. IRT: isovolumic relaxation time; ICT: isovolumic contraction time, ET: ejection time. Results 1. Left ventricular mass index (LVMI) was decreased after treatment in both groups, especially in benazepril group, showing the improvement of left ventricular hypertrophy 〔(146.90±15.10) vs (130.12±17.49) g/m 2 , P <0.05〕. 2. Ejection function (EF) was normal and E acceleration velocity (ACV E ) was increased in both groups 〔(589.55±176.94) vs (740.78±242.73) cm/s 2 ; (664.65±257.45) vs (853.61±269.05) cm/s 2 , P <0.01〕. IRT and ET were improved 〔(121.76±24.11) vs (95.51±24.62) ms, (258.84±38.73) vs (295.46±37.54) ms, P <0.01〕 and MPI was decreased significantly (0.61±0.13 vs 0.45±0.12, P <0.01) in losartan K group. Conclusions Benazepril HCL is an effective drug to invert left ventricular hypertrophy and improve the myocardial relaxation in elderly patients with essential hypertension. Losartan K is more effective in improving the left ventricular function in elderly patients with essential hypertension. Doppler-derived MPI combining systolic and diastolic function is a useful parameter and early indicator of left ventricular dysfunction in essential hypertensive patients with normal systolic function.

关 键 词：老年 高血压 左室肥厚 药物治疗 氯沙坦钾 盐酸苯那普利 多普勒超声心动图 

分 类 号：R541.3[医药卫生—心血管疾病]