林育锐

[摘要] 目的 观察美托洛尔联合前列腺素E1（PGE1）对老年充血性心力衰竭（CHF）患者血浆脑钠肽（BNP）浓度的变化及左室功能的影响。方法 100例老年CHF患者，随机分为联合组（美托洛尔加前列腺素E1）、美托洛尔组和正常对照组。正常对照组按心力衰竭常规治疗进行强心、利尿、扩管、降压等治疗，美托洛尔组在常规治疗的基础上加用美托洛尔，联合治疗组则在常规治疗的基础上联合应用美托洛尔和前列腺素E1。治疗8周后，比较3组患者血浆BNP浓度变化、心功能包括左室射血分数（LVEF）和心输出量（CO）的改善程度。 结果 治疗8周后联合组总有效率高于美托洛尔组（P＜0.05），高于对照组（P＜0.05）。与对照组相比,联合组血浆BNP水平、LVEF及CO均有明显改善；与美托洛尔组相比，联合组血浆BNP水平、LVEF及CO差异亦有统计学意义。结论 美托洛尔联合前列腺素E1可显著提高老年心力衰竭患者左心室射血分数和心输出量，降低BNP水平，值得临床参考和推广。

[关键词] 美托洛尔；前列腺素E1；心力衰竭；左室功能；脑钠肽

[中图分类号] R541.6   [文献标识码] B   [文章编号] 2095-0616（2014）08-69-04

Influence of metoprolol combined with prostaglandin E1 on cardiac function of elderly patients with heart failure

LIN Yurui

Department of Internal Medicine, Nan'ao People's Hospital,Nan'ao 515900,China

[Abstract] Objective To observe the influence of metoprolol combined with prostaglandin E1(PGE1) on the brain natriuretic peptide(BNP) concentration changes and left ventricular function of elderly patients with congestive heart failure(CHF). Methods 100 elderly patients with CHF were randomly divided into the combination group(metoprolol combined with prostaglandin E1), the metoprolol group and the normal control group. The normal control group received cardiotonic, diuretic, vascular dilation, antihypertensive treatment based on the conventional treatment of heart failure; The metoprolol group received additional metoprolol on the basis of conventional treatment; The combination group received metoprolol combined with prostaglandin E1 on the basis of conventional treatment. After 8 weeks of treatment, the plasma BNP concentration changes and cardiac function improvement degrees including left ventricular ejection fraction(LVEF) and cardiac output(CO) of the 3 groups of patients were compared. Results After 8 weeks of treatment, the combination group had higher total effective rate than the metoprolol group(P＜0.05) and the control group(P＜0.05).The plasma BNP level, LVEF and CO of the combination group were all improved significantly compared to those of the control group. The plasma BNP level, LVEF and CO of the combination group had statistically significant differences to those of the metoprolol group. Conclusion Metoprolol combined with prostaglandin E1 can significantly improve the left ventricular ejection fraction and cardiac output and reduce the BNP level of elderly patients with congestive heart failure, thereby worthy of clinical reference and promotion.

[Key words] Metoprolol; Prostaglandin E1; Heart failure; Left ventricular function; Brain natriuretic peptide

慢性心力衰竭是由各种疾病引起心肌收缩和（或）舒张功能障碍，心排血量降低，不足以维持机体组织正常代谢需要，而出现一系列症状和体征的一组临床综合征。主要表现为肺淤血和周围循环灌注不足[1-2]。根据美国Framingh研究显示，心力衰竭主要是中老年疾病，老人心力衰竭有心排出量明显降低，较易发生低氧血症，对负荷的心率反应低下的特点[3]。在老年人疾病中，老年人心力衰竭已成为老年人的主要死亡原因之一，我国老年心力衰竭占老年心血管疾病总数的76%左右，多是导致患者住院的主要病因，因此，对老年心力衰竭如何进行有效防治显得非常重要。……