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比索洛尔对慢性心力衰竭伴左室功能降低患者心肌和肺功能的保护作用 预览

Protective effect of bisoprolol on myocardial and pulmonary function in patients with chronic heart failure and left ventricular dysfunction
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摘要 目的 评价比索洛尔对慢性心力衰竭伴左室功能降低患者心肌和肺功能的保护作用。方法 2017年1月—2018年6月西安交通大学医学院第一附属医院心血管内科治疗慢性心力衰竭伴左心室功能降低患者182例,根据随机数字表法分为比索洛尔组( n =91)与卡维地洛组( n =91)。2组患者均进行规范抗心力衰竭治疗,比索洛尔组与卡维地洛组患者分别每日口服富马酸比索洛尔片和卡维地洛片。入院时和治疗24周后监测并比较2组患者心功能指标、心肌标记物水平、肺功能指标等。结果 治疗24周后,比索洛尔组和卡维地洛组患者左心室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、二尖瓣左室舒张早期血流峰值速度(E)与二尖瓣环舒张早期运动峰值速度(e’)比值(E/e')、右室直径(RVD)及NYHA心功能分级等超声心动图指标均较入院时显著改善(比索洛尔组: t =4.881、7.866、11.796、4.013、2.879,χ^2=127.431, P 均<0.01;卡维地洛组: t =6.423、 5.521、 8.148、3.799、3.662,χ^2=108.040, P 均<0.01)。治疗后,2组患者N-末端脑钠肽前体(NT-proBNP)均较治疗前显著降低(比索洛尔组: t =5.054, P <0.01;卡维地洛组: t =5.023, P <0.01),比索洛尔组超敏肌钙蛋白T(hs-TnT)较治疗前显著降低( t =21.689, P <0.01)。治疗后比索洛尔组患者FVC、FEV 1与MVV均较治疗前显著改善( t = 3.257、 2.586 、6.123, P 均<0.01),且改善优于卡维地洛组( t =2.612、2.189、4.199, P 均<0.01)。2组患者不良反应发生率比较差异无统计学意义(χ^2=0.098, P =0.754)。结论 比索洛尔和卡维地洛治疗慢性心力衰竭伴左心室收缩功能降低患者疗效和安全性相似,但比索洛尔对慢性心力衰竭患者心肌和肺功能的保护作用优于卡维地洛。 Objective To evaluate the protective effect of bisoprolol on myocardial and pulmonary function in patients with chronic heart failure and left ventricular dysfunction. Methods From January 2017 to June 2018,182 patients with chronic heart failure and left ventricular dysfunction were divided into bisoprolol group ( n =91) and carvedilol group ( n =91) according to random number table. Both groups received standard anti-heart failure treatment. Bisoprolol fumarate tablets and carvedilol tablets were orally administered daily to the patients in the bisoprolol group and carvedilol group,respectively. Cardiac function index,myocardial marker level and pulmonary function index were monitored and compared between the two groups at admission and 24 weeks after treatment. Results After 24 weeks of treatment,left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),left ventricular ejection fraction (LVEF),ratio of mitral early diastolic peak velocity (E/e'),right ventricular diameter (RVD) and NYHA cardiac function grading were measured in bisoprolol group and carvedilol group. The indexes of echocardiography were significantly improved compared with those at admission ( t =4.881,t =7.866,t =11.796,t =4.013,t =2.879,χ^2= 127.431,P <0.01;t =6.423,t =5.521,t =8.148,t =3.799, t = 3.662,χ^2 = 108.040,P <0.01). After treatment,the N-terminal brain natriuretic peptide precursor (NT-proBNP) in both groups was significantly lower than that before treatment (bisoprolol group: t =5.054,P <0.01;carvedilol group: t = 5.023 ,P <0.01). Hypersensitive troponin T (hs-TnT) in bisoprolol group was significantly lower than that before treatment ( t = 21.689,P <0.01). FVC,FEV 1 and MVV in bisoprolol group were significantly improved after treatment ( t =3.257, t = 2.586,t =6.123,P <0.01),and were better than those in carvedilol group ( t =2.612,t =2.189,t =4.199,P <0.01). There was no significant difference in the incidence of adverse reactions between the two groups (χ 2=0.098,P = 0.754 ). Conclusion Bis
作者 梁秀利 任丽 寇惠娟 高登峰 马瑞 LIANG Xiuli;REN Li;KOU Huijuan;GAO Dengfeng;MA Rui(Department of Pharmacy, the First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an 710061, China)
出处 《疑难病杂志》 CAS 2019年第2期109-113,118共6页 Journal of Difficult and Complicated Cases
基金 陕西省科学技术计划项目(2015K12-G2).
关键词 心力衰竭 慢性 比索洛尔 心肌损伤 肺功能 保护作用 Heart failure,chronic Bisoprolol Myocardial injury Pulmonary function Protective effect
作者简介 通信作者:梁秀利,E-mail: liangxiulixa@sohu.com.
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