摘要
目的:应用无创伤性的多普勒技术评估卡维地洛对充血性心力衰竭患者左室功能影响。方法:于2003-08/2005-09选择山东大学第一人民医院心内科住院的心力衰竭患者60例,按随机数字表法分为两组,卡维地洛组和常规治疗组,每组30例。卡维地洛组在给予洋地黄、利尿剂等药物常规抗心力衰竭的基础上加用卡维地洛,起始剂量3.125mg,1次/d,1周后逐渐增量为3.125mg,2次/d。4周后增量为6.25mg,2次/d。若患者病情稳定,8周后增量为12.5mg,2次/d,此剂量维持6个月。常规治疗组除不用卡维地洛外其他治疗相同。两组患者在服药前及服药6个月后观察心功能分级,应用超声心动图测量心脏形态的变化,心脏收缩和舒张功能指标。结果:①心功能分级:卡维地洛长期服用能使患者心功能分级得到改善,治疗效果优于常规治疗(卡维地洛治疗后心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为14,10,6,0例;常规治疗后心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为4,9,13,4例)。②心脏形态:卡维地洛治疗后左房、左室内径小于治疗前[分别为(33.4±11.6),(46.5±9.6)mm;(57.8±5.6),(64.8±6.5)mm],差异有显著性意义(t=4.4688,P<0.05;t=4.7653,P<0.01),常规治疗组前后无明显变化(P>0.05)。两组右房、右室内径及室间隔、左室后壁厚度治疗前后亦无明显变化。③心脏收缩和舒张功能指标:卡维地洛组患者治疗6个月后左室的收缩和舒张功能明显改善,表现在左室最大上升速率、主动脉血流最大速度及左室最大下降速率的绝对值增大,左室射血分数升高,左室射血前期、左室射血时间、加速时间缩短,左室等容舒张期时间缩短,二尖瓣血流舒张早期最大流速升高,二尖瓣血流心房收缩期最大流速降低,E波与A波流速比值升高。结论:超声心动图结果显示,卡维地洛能明显改善充血性心力衰竭患者左室的收缩和舒张功能,减轻左心室的重构。
AIM： To research the effect of carvedilol on left ventricular function of patients with congestive heart failure （CHF） by nontraumatic Doppler technology. METHODS： Sixty patients with CHF from Department of Cardiology, First People＇s Hospital of Jinan from August 2003 to September 2005, were randomly divided into carvedilol group and control group. Each group contained 30 cases. Control group patients were treated with conventional drugs such as digitalis and diureticum etc. Carvedilol was added on the basement of conventional drugs to carvedilol group patients. Initial dose of carvedilol was 3.125 mg once daily, then gradually increased to 3.125 mg twice daily after one week, 6.25 mg twice daily after four weeks, and 12.5 mg twice daily after 8 weeks. This dose was maintained for 6 months. The cardiac morphology, contractile and diastolic function indices were measured before and six months after treatment by echocardiogram. RESULTS： ① Cardiac function grade： Long administration of carvedilol improved the cardiac function grade of patients, and the effect was superior to conventional therapy （carvedilol group： Ⅰ,Ⅱ, Ⅲ, Ⅳ grades were 14, 10, 6, 0 cases; control group： Ⅰ,Ⅱ, Ⅲ, Ⅳ grades were 4, 9, 13, 4 cases）.②Heart morphology： The inner diameters of left atrium and left ventricle were significantly shorter in carvedilol group after the treatment [（33.4±11.6）, （46.5±9.6） ram; （57.8±5.6）, （64.8±6.5） mm, t =4.468 8, P 〈 0.05; t =4.765 3, P 〈 0.01], and no obvious change was found in the control group （P 〉 0.05）. The inner diameter and interventricular septum of right atrium and right ventricle, and thickness of posterior left ventricle remained after the treatment. ③Cardiac contractile and diastolic function indices： The left ventricular contractile and diastolic function of carvedilol group were improved significantly after 6 months. Statistical analysis showed that left ventricular maximal upstroke velocity, maximal rate of left ventricular pressure change and absolute value of left ventricular falling pressure, left ventricular ejection fraction were raised obviously; left ventricular preejection period, left ventricular ejection time and accelerating time, left ventricular isovolumetric relaxation time were shortened significantly; peak flow rate of mitral valvular blood flow relaxation earlier period （E wave） raised; peak flow rate of mitral valvular blood flow atrial systole period （A wave） degraded, and the flow rate ratios of E wave and A wave increased markedly. CONCLUSION： The result of ultrasonic cardiogram shows that carvedilol can improve the left ventricular contractile and diastolic function and alleviate left ventricular reconstruction in the patients with CHF.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第13期2537-2539,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
