摘要
目的研究氢氯噻嗪、依那普利、美托洛尔、螺内酯联合治疗扩张型心肌病(DCM)的疗效。方法DCM患儿23例,纽约心脏病协会(NYHA)心脏功能Ⅲ-Ⅳ级,确诊病例予氢氯噻嗪、依那普利、螺内酯口服,心功能Ⅳ级者加用小剂量地高辛口服,顽固性心衰患儿加用多巴胺、多巴酚丁胺静滴。心功能改善到Ⅱ-Ⅲ级时加用美托洛尔口服,2-4周将依那普利、美托洛尔剂量加倍,每2-4周抽血观察肾脏功能和血清钾。服药后1、3、6、12、24个月随访患儿.病情恶化者再次住院治疗。各随访阶段均判断心脏功能,检查同步12导联体表心电图(12-ECG)、二维超声心动图(2-DE),用2-DE测量患儿左心房(LA)、左心室(LV)内径及左室射血分数(EF)、短轴缩短率(FS)。结果随访1-26个月,病例均遵医嘱用药。随访死亡3例,死因为严重肺部感染、窒息。12-ECG示心房纤颤2例,未使用抗心律失常药物治疗,6个月后自行转复为窦性心律,每2-4周观察肾脏功能和血清钾结果正常。治疗前EF、FS分别为(42.45±13.07)%和(21.14±8.06)%,用药后随访3个月时接近60%和30%,12个月时>60%和.30%;LA、LV内径治疗前分别为(28.96±8.54)mm及(46.09±14.09)mm,随访3个月时(26.00±0.01)mm及(40.50±212)mm,治疗3个月后LA、LV明显缩小(t=-2.892,-4.509P<0.05,0.01)。结论联合应用氢氯噻嗪、依那普利、美托洛尔、螺内酯治疗小儿DCM能明显延缓或防止心肌重塑进展,改善心脏功能,提高生存质量。
Objective To evaluate the clinical effect of therapeutic alliance with dihydrochlorothiazide, enalapril, metoprolol and spironolactone for dilated cardiomyopathy （DCM） in children. Methods Twenty - three children with DCM aged 3 months to 17 - year - old with heart functions class Ⅲ - Ⅳ according to NYHA standard were administered oral drug preparation of dihydrochlorothiazide, enalapril and spironolactone. Patients whose heart function was class Ⅳ were added to small dosage digoxin intake orally. Obstinate heart failure cases were given dopamine and dobutanline by intravenous drip. After patients＇ heart failure achieved Clasps Ⅱ - Ⅲ, they took orally metoprolol. The patients＇ renal function and ,serum potassium were tested every 2 - 4 weeks. The drugs of enalapril and metoprolol were given doubling dosage after 2 - 4 weeks. Patients were followed up at intervals of 0, 1, 3, 6, 12 and 24 months after treatment. They should be hospitalized again if their conditions became deteriorated in the course of treatment. The heart function class and 12 - lead simuhaneous surface electrocardiogram （ 12 - ECG） and 2 dimensional echoeardiogram （2 - DE） were tested in each follow - up stage. The dianleters of left atrium （LA） and left ventricle （LV） and the left ventricular ejection fraction （EF） and fractional shortening （FS） were detected by 2 - DE. Results Patients of DCM were followed up during（ 1 - 26）month. All patients followed physician＇s order. Three patients died of serious lung infection and asphyxia. Two patients showed atrial fibrillation in 12 - ECG. They conversed sinus rhythm after six months and didn＇t take antiarrhythmic drugs. The patients＇ renal function and serum potassium were normal every 2 - 4 weeks. EF and FS were （42.45 ± 13.07） % and （21.14 ± 8.06） % pretherapy and near 60% and 30% in the following 3 months and more than 60% and 30% in the following 12 months. The diameters of LA and LV were （28.96 ± 8.54）mm and （46.09 ± 14.09）mm pretherapy and （26.00 ± 0.01 ）mm and（40.50 ＋ 2.12）mm in the following 3 months. LA and LV diminished in size in 3 months than those of pretherapy （ t = - 2. 892, - 4. 509 P 〈0 .05,0.01 ）. Conclusion Therapeutic alliance with dihydrochlrothiazide, enalapril,metoprolol and spironolactone may help to postpone or prevent myocardium remodeling, and to recover heart function and raise existing quality in children with DCM.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2005年第10期992-994,共3页
Journal of Applied Clinical Pediatrics
关键词
神经内分泌拮抗剂
心肌病
扩张型
心力衰竭
儿童
neuroendocrine antagonist
dilated cardiomyopathy
heart failure
children
