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目的探讨卡维地洛联合螺内酯在慢性心力衰竭患者治疗中的疗效、耐受性和安全性。方法 190例心衰患者随机分为观察组(卡维地洛与螺内酯联合治疗组)99例和对照组(常规治疗组)91例,两组患者均经常规强心、利尿、扩血管、抗感染、氧疗、解痉平喘及对症支持等综合治疗;观察组在常规治疗基础上联合应用卡维地洛与螺内酯。随访半年,治疗前后采用超声心动图测量心功能,进行疗效观察。结果治疗后两组LVEDD、LVESD均较治疗前显著减少(P<0.05);LVEF较治疗前显著增高(P<0.05)。卡维地洛联合螺内酯组LVEDD、LVESD均低于常规治疗组(P<0.05),LVEF较常规治疗组显著增高,有统计学意义(P<0.05)。卡维地洛联合螺内酯组多见的不良反应为头晕,两组均未发现肝肾功能损害及血象、电解质和血糖变化。结论卡维地洛联合螺内酯在心衰标准用药基础上治疗慢性充血性心衰患者安全、有效,可显著改善左室重塑。
Objective To investigate the efficacy, tolerability and safety of carvedilol combined with spironolactone in the treatment of patients with chronic heart failure. Methods Totally 190 patients with heart failure were randomly divided into observation group (combination group of carvedilol and spironolactone) and control group (n = 91), 91 patients in both groups were given routine cardiac, diuretic, vasodilator, Infection, oxygen therapy, antispasmodic and asthma and symptomatic support and other comprehensive treatment; observation group on the basis of conventional treatment combined with carvedilol and spironolactone. Follow-up for six months, before and after treatment using echocardiography measurement of cardiac function, the efficacy observed. Results After treatment, LVEDD and LVESD in both groups were significantly lower than those before treatment (P <0.05); LVEF was significantly higher than that before treatment (P <0.05). LVEDD and LVESD in carvedilol combined spironolactone group were lower than those in conventional treatment group (P <0.05), LVEF was significantly higher than conventional treatment group, with statistical significance (P <0.05). Carvedilol combined spironolactone group more common side effects were dizziness, liver and kidney dysfunction and blood, electrolyte and blood glucose were not found in both groups. Conclusion Carvedilol combined with spironolactone is safe and effective in the treatment of patients with chronic congestive heart failure on the basis of standard medication of heart failure, and can significantly improve left ventricular remodeling.