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目的 :评价血管紧张素Ⅱ受体拮抗剂、血管紧张素转换酶抑制剂 (ACEI)及两者合用治疗充血性心力衰竭的临床效果。 方法 :6 0例患者随机分为卡托普利组、氯沙坦组和联合用药组 ,于入院时行NYHA心功能分级 ,超声心动图测定左室射血分数 (LVEF)、左室收缩末容积 (LVESV)、左室舒张末容积 (LVEDV) ,治疗 1、3、6、12个月复查上述指标。 结果 :卡托普利组与联合用药组治疗 1个月时心功能、LVESV、LVEDV、LVEF值均有显著改善 ,优于氯沙坦组 ,卡托普利组LVEF和LVESV有随着服药时间的延长进一步好转的趋势 ,联合用药组用药 3个月后各项指标处于稳定状态 ,氯沙坦组服药 3个月各项指标才开始发生变化 ,服药 3、6、12个月 3组间比较差异无统计学意义。 结论 :血管紧张素Ⅱ受体拮抗剂与ACEI均可逆转左心室重塑和防治心力衰竭 ,在心力衰竭的长期治疗中可获得相同的益处 ,但心力衰竭急性期宜选用ACEI ,可尽快改善临床症状 ,联合应用两种药物并未显示出叠加的优势且增加了患者的经济负担。
Objective: To evaluate the clinical effect of angiotensin Ⅱ receptor antagonist, angiotensin converting enzyme inhibitor (ACEI) and their combination in the treatment of congestive heart failure. Methods Sixty patients were randomly divided into captopril group, losartan group and combination group. NYHA functional class was performed on admission. The left ventricular ejection fraction (LVEF), left ventricular end-systolic pressure Volume (LVESV), left ventricular end diastolic volume (LVEDV), the treatment of 1,3,6,12 months review of the above indicators. Results: The cardiac function, LVESV, LVEDV and LVEF in captopril group and combination group were significantly improved at 1 month, which were better than those in losartan group and captopril group. LVEF and LVESV in captopril group were significantly lower than those in control group The further improvement of the trend of the extension of the drug combination group after 3 months of use of the indicators in a stable state, losartan group medication 3 months began to change the various indicators, taking 3,6,12 months after the comparison between the three groups The difference was not statistically significant. Conclusion: Both angiotensin Ⅱ receptor antagonist and ACEI can reverse left ventricular remodeling and prevent heart failure. The same benefit can be obtained in the long-term treatment of heart failure. However, ACEI should be used in the acute phase of heart failure to improve the clinical Symptoms, combined use of two drugs did not show the advantages of superposition and increase the patient’s financial burden.