摘要
目的 探讨低剂量螺内酯对严重心力衰竭 (心衰 )的临床疗效。方法 对 85例严重心力衰竭患者 ( NYHA分级 - 级 ,心脏射血分数 <3 5 % )进行随机双盲实验。常规抗心衰治疗 ,2 0mg/d的螺内酯治疗 ,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 ,最后评价其死亡率。结果 对照组高钾血症的发生率为 4 .8% ,治疗组高钾血症的发生率只有 9.3 % ,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结果显示 1年前后螺内酯治疗组每小时室性早搏的发生频率 ( P <0 .0 0 0 1)和 2 4 h非持续性室性心动过速的发作率均有明显减少。1年对照组死亡 19例 ( 4 5 .2 % ) ,治疗组死亡 12例 ( 2 7.9% ) ,死亡率下降 3 8% ,两者比较差异有显著性 ( P <0 .0 5 )。结论 小剂量醛固酮拮抗剂螺内酯 ( 2 0 mg/d)用来治疗严重心力衰竭疗效肯定 ,副作用小 ,较为安全 ,能有效降低严重心力衰竭患者的死亡率。
Objective To study the curative effect of low dose spironolactone to severe heart failureMethods In a randomized double blind study we enrolled 85 patients with severe heart failure (NYHA class Ⅲ Ⅳ and a left ventricular ejection fraction less than 35%). They were treated by anti heurt failure.The treatmet group treatment received 20 mg of spironolactone daily,and the control group received placebo.All the procedures had been performed for 12 months.Serum levels of creatinine,ureanitrogen and potassium and the changes of pulse and blood pressure were measured periodically.Holter monitoring was used to assess the ventricular arrhythmia.And at last the mortality rate of the patients was calculated.Results The incidence of hyperkalemia in the control group and the treatment group were 4.8% and 9.3%,respectively. Compared with the control group,systolic and diastolic arterial pressure decreased and serum levels of creatinine and urea nitrogen did not significantly change in the treatment group.Hotler minitoring analysis in one year there was apparently decrease in the hourly frequency of ventricular premature complexes(P<0.0001)and episodes of nonsustained ventricular tachycardia.In a year 19(45.2%)and 12(27.8%)cases died in the controt group and spironolacton the 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 of patients with severe heart failure. It has minimal adverse effects and is effective in reversing the reconstruction of the heart and blood vessels, therefore it is effective in reducing the mortality rate of the cases with severe heart failure.
出处
《临床内科杂志》
CAS
北大核心
2001年第6期447-449,共3页
Journal of Clinical Internal Medicine
关键词
螺内酯
醛固酮
心力衰竭
药物治疗
心血管重构
疗效
Spironolactone
Aldosterone
Heart failure/drug therapy
Cardiovascular reconstruction
