中国基层医药
中國基層醫藥
중국기층의약
Chinese Journal of Primary Medicine and Pharmacy
2015年
23期
3539-3541,3542
,共4页
陈春泉%王敏%李庆丰%翁小雁%陈积党
陳春泉%王敏%李慶豐%翁小雁%陳積黨
진춘천%왕민%리경봉%옹소안%진적당
心力衰竭,充血性%美托洛尔
心力衰竭,充血性%美託洛爾
심력쇠갈,충혈성%미탁락이
Heart failure,congestive%Metoprolol
目的：评价美托洛尔剂量调整对老年人慢性充血性心力衰竭急性加重期的临床疗效和对预后的影响，为临床治疗方案的制定提供参考依据。方法选取慢性充血性心力衰竭（CHF）急性加重患者76例，在接受美托洛尔配合其他合理治疗的基础上，按随机数字表法分为阻滞剂剂量减半组（40例）和全停组（36例）；调整3个月后，观察患者剂量调整后的临床症状，用无创血流动力学检测仪测量心指数（CI）、左心做功（LCW）、心输出量（CO）等指标变化，用免疫放射分析法分析血浆 B 型钠尿肽（BNP）水平。结果按照前述方案给予治疗后72 h 密切关注病情，剂量减半组病情进展13例，好转27例；全停组进展20例，好转16例。两组病情好转率差异有统计学意义（χ2＝4．09，P ＜0．05）；美托洛尔调整后两组上述指标比较，差异均有统计学意义（χ2＝4．52，P ＜0．05），减半组 NYHA 分级、CO、CI、LCW 较调整之前变化不明显，全停组 NYHA 变化明显，III ／IV 病情发展病例数增加5例和3例，CO、CI、LCW 分别减小约25％、35％、30％。美托洛尔调整后，美托洛尔减半组 BNP（321．8±97．6）mg／L，明显低于美托洛尔全停组的（422．3±139．4）mg／L，差异有统计学意义（t ＝3．94，P ＜0．05）。结论在接受美托洛尔配合其他合理治疗的基础上，CHF 患者急性加重期减半应用比停用预后较好，且安全性高。
目的：評價美託洛爾劑量調整對老年人慢性充血性心力衰竭急性加重期的臨床療效和對預後的影響，為臨床治療方案的製定提供參攷依據。方法選取慢性充血性心力衰竭（CHF）急性加重患者76例，在接受美託洛爾配閤其他閤理治療的基礎上，按隨機數字錶法分為阻滯劑劑量減半組（40例）和全停組（36例）；調整3箇月後，觀察患者劑量調整後的臨床癥狀，用無創血流動力學檢測儀測量心指數（CI）、左心做功（LCW）、心輸齣量（CO）等指標變化，用免疫放射分析法分析血漿 B 型鈉尿肽（BNP）水平。結果按照前述方案給予治療後72 h 密切關註病情，劑量減半組病情進展13例，好轉27例；全停組進展20例，好轉16例。兩組病情好轉率差異有統計學意義（χ2＝4．09，P ＜0．05）；美託洛爾調整後兩組上述指標比較，差異均有統計學意義（χ2＝4．52，P ＜0．05），減半組 NYHA 分級、CO、CI、LCW 較調整之前變化不明顯，全停組 NYHA 變化明顯，III ／IV 病情髮展病例數增加5例和3例，CO、CI、LCW 分彆減小約25％、35％、30％。美託洛爾調整後，美託洛爾減半組 BNP（321．8±97．6）mg／L，明顯低于美託洛爾全停組的（422．3±139．4）mg／L，差異有統計學意義（t ＝3．94，P ＜0．05）。結論在接受美託洛爾配閤其他閤理治療的基礎上，CHF 患者急性加重期減半應用比停用預後較好，且安全性高。
목적：평개미탁락이제량조정대노년인만성충혈성심력쇠갈급성가중기적림상료효화대예후적영향，위림상치료방안적제정제공삼고의거。방법선취만성충혈성심력쇠갈（CHF）급성가중환자76례，재접수미탁락이배합기타합리치료적기출상，안수궤수자표법분위조체제제량감반조（40례）화전정조（36례）；조정3개월후，관찰환자제량조정후적림상증상，용무창혈류동역학검측의측량심지수（CI）、좌심주공（LCW）、심수출량（CO）등지표변화，용면역방사분석법분석혈장 B 형납뇨태（BNP）수평。결과안조전술방안급여치료후72 h 밀절관주병정，제량감반조병정진전13례，호전27례；전정조진전20례，호전16례。량조병정호전솔차이유통계학의의（χ2＝4．09，P ＜0．05）；미탁락이조정후량조상술지표비교，차이균유통계학의의（χ2＝4．52，P ＜0．05），감반조 NYHA 분급、CO、CI、LCW 교조정지전변화불명현，전정조 NYHA 변화명현，III ／IV 병정발전병례수증가5례화3례，CO、CI、LCW 분별감소약25％、35％、30％。미탁락이조정후，미탁락이감반조 BNP（321．8±97．6）mg／L，명현저우미탁락이전정조적（422．3±139．4）mg／L，차이유통계학의의（t ＝3．94，P ＜0．05）。결론재접수미탁락이배합기타합리치료적기출상，CHF 환자급성가중기감반응용비정용예후교호，차안전성고。
Objective To evaluate the effects and the prognosis of beta receptor blocker (metoprolol)dose adjustment of senile patients with chronic congestive heart failure (CHF)of acute exacerbation,and to provide reference for clinical treatment.Methods 76 cases with chronic CHF in acute exacerbation who treated with beta blockers and other reasonable treatment were randomly divided into half dose group (40 cases)and full stop group (36 cases).After adjusted for 3 months,the clinical symptoms were observed,noninvasive hemodynamic machine was used to detect cardiac index (CI),left cardiac work (LCW),cardiac output (CO)and changes of other indicators. Immunoradiometric analysis was used to detect plasma type B natriuretic peptide (BNP).Results 72h after treatment,in the half dose group,the progression of the disease in 13 cases,improved in 27 cases,in the full stop group,progression in 20 cases,improvement in 16 cases,the difference was statistically significant (χ2 =4.09,P <0.05).Before the adjustment of metoprolol,the index of the two groups had statistically significant difference(χ2 =4.52,P <0.05 ).Compared with pretreatment,the changes of NYHA classification,Co,CI,LCW of the half dose group were not obvious,and he change of NYHA of the full stop group was obvious,,III /IV the progression of the disease the number of cases increased in 5 cases and 3 cases,Co,Ci,LCW were reduced by about 25%,35% and 30%.After the adjustment of metoprolol,BNP of the half dose group was (321.8 ±97.6 )mg/L,which was significantly lower than (422.3 ±139.4)mg/L of the full stop group,the difference was statistically significant (t =3.94,P <0.05 ).Conclusion In the patients with beta blockers combined with other reasonable treatment, CHF patients with acute exacerbation of the beta blockers than the discontinuation of the prognosis,and the safety is high.
