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目的 :评价卡维地洛治疗国人扩张型心肌病 (DCM )心力衰竭的耐受性。方法 :对NYHAⅡ～Ⅳ级DCM患者在常规治疗 (强心、利尿、扩血管 )基础上加用卡维地洛 ,起始剂量 5mg/d ,如能耐受则逐渐滴定到最大耐受量 ,通过临床监测及调查表随访观察其不良事件。结果 :① 34例正式应用卡维地洛治疗的DCM患者至随访结束后平均卡维地洛用量为 (2 9.0 6± 6 .5 4 )mg/d ,临床疗效好 ;②卡维地洛大剂量 (≥ 35mg/d ,n =17)者舒张压、收缩压明显高于卡维地洛小剂量者 (≤ 30mg/d ,n =17) ,P <0 .0 5 ;前者年龄明显低于后者 (P <0 .0 5 ) ,但两组间心率、心功能、左室射血分数、短轴缩短率、6 0min步行距离差异无显著性意义 (P >0 .0 5 ) ;③不良事件共4 4次 ,主要包括 :乏力、腹胀、头昏等 ;④不良事件主要发生在 5mg/d及 10mg/d时的初始期及 30～ 4 0mg/d的耐受量期 ,与剂量无显著关系。结论 :我国DCM患者对第三代 β受体阻滞剂卡维地洛的耐受性好 ,不良事件少 ,安全性高
OBJECTIVE: To evaluate the tolerability of carvedilol in the treatment of heart failure in patients with dilated cardiomyopathy (DCM) in China. Methods: Carvedilol was added to NYHA class Ⅱ to Ⅳ DCM patients on the basis of conventional therapy (cardiac, diuretic and vasodilator). The initial dose was 5 mg / d. If tolerated, the titer was titrated to the maximum tolerated dose, Adverse events were observed by clinical monitoring and questionnaire follow-up. Results: (1) The average amount of carvedilol in 34 patients with DCM treated with carvedilol at the end of follow-up was (2 9.06 ± 6.50) mg / d, and the clinical efficacy was good. ② Carvedilol Diastolic blood pressure and systolic blood pressure were significantly higher than those of low dose of carvedilol (≤30mg / d, n = 17) at the dosage of 35 mg / d (n = 17, n = 17) (P <0.05). There was no significant difference between the two groups in heart rate, heart function, left ventricular ejection fraction, short axis shortening and walking distance at 60min (P> 0.05). A total of 4 4 adverse events, including: fatigue, bloating, dizziness, etc .; ④ adverse events occurred mainly in the initial 5mg / d and 10mg / d and 30 ~ 40mg / d tolerance period, and dose No significant relationship. Conclusion: DCM patients in our country are well tolerated by the third-generation β-blocker carvedilol, with fewer adverse events and high safety