[标准三联法联合缬沙坦、美托洛尔治疗充血性心力衰竭的临床疗效与安全性观察]充血性心衰名词解释

　　[摘要] 目的 观察标准三联法联合缬沙坦、美托洛尔治疗慢性充血性心力衰竭的临床疗效与安全性，探讨此方案的作用机制。 方法 将88例充血性心力衰竭患者按随机、对照、开放原则分为观察组44例和对照组44例，对照组进行标准的三联疗法，观察组在对照组基础上，增加美托洛尔、缬沙坦治疗，1个月为1个疗程，治疗前后观察患者临床症状和体征，检测彩色B超评价心功能的变化。 结果 观察组总有效率为95.45%，对照组总有效率为59.09%，观察组总有效率显著高于对照组，差异有高度统计学意义（P ＜ 0.01）；治疗后，两组血压差异不明显，观察组心率、左室舒张末期内径（LVDD）明显低于对照组，左室射血分数（LVEF）明显高于对照组，差异有高度统计学意义（P ＜ 0.01）。 结论 标准三联法联合缬沙坦、美托洛尔治疗慢性充血性心力衰竭临床疗效确切，能更好改善左室收缩功能，降低心率，改善心功能，提高治疗总有效率，逆转心室重朔，且患者耐受性好，使慢性心力衰竭患者获得较大的临床益处，是一种理想的治疗方案。
　　[关键词] 标准三联法；缬沙坦；美托洛尔；充血性心力衰竭；临床应用
　　[中图分类号] R541.61 [文献标识码] A [文章编号] 1673-7210（2012）07（b）-0054-03
　　Observation of clinical efficacy and safety of the treatment of congestive heart failure by standard triple method combined with Valsartan and Metoprolol
　　ZHU Jingwei
　　The People"s Hospital of Taishan City in Guangdong Province, Taishan 529200, China
　　[Abstract] Objective To observe the clinical efficacy and safety of the treatment of congestive heart failure by Standard triple method combined with Valsartan, Metoprolol, to explore the mechanism of action of this program. Methods 88 patients with congestive heart failure were randomly divided into 44 cases of observation group and 44 cases of control group. The control group was given standard triple therapy, the observation group increased Metoprolol and Valsartan on the basis of the control group, one month for a course of treatment, the clinical signs and symptoms were observed, the change of cardiac function were observed by color B before and after treatment. Results The total effective rate of observation group was 95.45%, the control group was 59.09%, the observation group was significantly higher than the control group (P ＜ 0.01); after treatment, the heart rate and LVDD of the observation group were significantly lower than the control group, the LVEF were significantly higher, the differences were statistically significant (P ＜ 0.01). Conclusion The method, which contains standard triple method combined with Valsartan, Metoprolol, has clinical efficacy, can be able to improve left ventricular systolic function more, decrease heart rate and improve cardiac function, increase the total effective rate and reversal of ventricular re-moon, and well tolerate in patients, has a greater clinical benefit for chronic heart failure patients, which is an ideal treatment program.
　　[Key words] Standard triple method; Valsartan; Metoprolol; Congestive heart failure; Clinical application
　　充血性心力衰竭是由于原发性心肌损害和心脏负荷过重，导致心脏功能受损，心排血量下降，导致动脉搏系统缺血、静脉系统瘀血而出现的临床综合征，是心内科面临的重要课题。传统治疗模式进局限于纠正血流动力学异常和缓解症状，采用标准三联法治疗，即给予利尿剂、强心剂、ACEI治疗，但随着疾病研究的深入，对神经内分泌激活和心室重塑的干预得到临床医生的逐步认可[1]。本文笔者在标准三联法治疗的基础上，增加血管紧张素Ⅱ受体拮抗剂缬沙坦和β受体阻滞剂美托洛尔治疗充血性心力衰竭患者，获得良好临床疗效，现将临床结果及作用机制分析报道如下：