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比索诺尔联合福辛普利治疗扩张型心肌病合并室性心律失常临床研究*

作者:许有凡1 黄文平2 张相杰1 黎友琴1 王文浩1

所属单位:1.广东省东莞市厚街医院心血管内科 (广东 东莞 523945)2.广东省东莞市厚街医院特诊社康中心 (广东 东莞 523945)

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摘要

目的 观察评价不同剂量比索诺尔联合福辛普利治疗扩张型心肌病(DCM)合并室性心律失常患者的临床效果。方 法 将90例扩张型心肌病合并室性心律失常的患者,并按照数字表法分为两组,对照组45例给予比索洛尔(5mg)和 福辛普利(10mg),观察组45例给予比索洛尔(10mg)和福辛普利(20mg)。比较两组临床效果。结果 观察组总有效率 95.56%明显高于对照组82.22%(χ2 =4.0500,P<0.05),两组治疗后BNP、CRP均显著降低(P<0.05),观察组治疗后 BNP、CRP均低于对照组(P<0.05),两组治疗后LVEDV均显著升高,而LVESV、LVEDD均显著降低(P<0.05),且观察 组各项心功能指标均明显的优于对照组(P<0.05),两组治疗后室性早搏总次数、室早二联律、三联律、短阵室速 发作次数均显著降低(P<0.05),且观察组各项心律失常指标均明显低于对照组(P<0.05)。结论 大剂量比索洛尔 联合福辛普利治疗DCM合并室性心律失常的临床疗效显著,可明显降低BNP、CRP指标,有效改善心功能和心律失常 状态改善预后。

Objective To evaluate the clinical effects of different doses of bisoprolol combined with fosinopril in the treatment of patients with dilated cardiomyopathy (DCM) complicated with ventricular arrhythmia. Methods Ninety patients with dilated cardiomyopathy complicated with ventricular arrhythmia were divided into two groups according to the digital table method. 45 patients in the control group were given bisoprolol (5mg) and fosinopril (10mg), and 45 patients in the observation group. Bisoprolol (10mg) and fosinopril (20mg) were administered. The clinical effects of the two groups were compared. Results The total effective rate of the observation group was 95.56%, which was significantly higher than that of the control group 82.22%, χ2 =4.0500, P<0.05). The BNP and CRP were significantly decreased after treatment (P<0.05). The BNP and CRP were observed in the observation group. Compared with the control group (P<0.05), LVEDV was significantly increased after treatment, while LVESV and LVEDD were significantly decreased (P<0.05), and the cardiac function indexes of the observation group were significantly better than the control group (P<0.05), the total number of ventricular premature beats, ventricular premature dysfunction, triple syndrome, and short ventricular tachycardia were significantly lower in the two groups (P<0.05), and the arrhythmia indexes in the observation group were significantly lower than those in the observation group. Control group (P<0.05). Conclusion High-dose bisoprolol combined with fosinopril in the treatment of DCM with ventricular arrhythmia has a significant clinical effect, can significantly reduce BNP, CRP indicators, and effectively improve cardiac function and arrhythmia status to improve prognosis.

【关键词】比索洛尔;福辛普利;扩张型心肌病;室性心律失常;不同剂量

【中图分类号】R542.2;R541.7

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2018.04.008

前言

扩张型心肌病(dilated cardiomyopathy,DCM) 以心腔扩张和心功能减退为特点的心肌病[1-2]。DCM是 一类既有遗传又有非遗传因素造成的复合型心肌病, 该病多起病缓慢,部分患者的病程可达10年以上。早期以活动或劳累后气短,或有夜间阵发性呼吸困难, 后期表现为顽固性充血性心力衰竭[3-4]。由于患者心 脏结构的改变,心脏的神经电生理通路也明显异常, 故DCM患者常会合并各种心律失常。而心律失常是一种病死率很高、发病特别急的危重疾病[5]。优化药物 治疗是DCM的治疗基础,福辛普利是血管紧张素转换 酶抑制剂,能减少血管紧张素Ⅱ含量,适用于治疗不 同程度的高血压、心力衰竭,是临床普遍认可的改善 心室重构的治疗药物,比索洛尔是高选择性β受体阻 断剂,有效的改善心肌收缩功能[6-7]。我院结合自身 病例分析不同剂量比索洛尔联合福辛普利对DCM合并 室性心律失常患者的临床疗效,报道如下。