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目的研究分析不同剂量美托洛尔在慢性充血性心力衰竭治疗中的临床效果。方法选取收住郑州大学第一附属医院的慢性充血性心力衰竭患者56例为对照组,同期入院患者50例为试验组。两组患者入院后均积极给予强心、利尿及扩血管等常规药物治疗。在此基础上,对照组给予小剂量美托洛尔,起始剂量6.25~12.5 mg/d,维持量25~75 mg/d,最大剂量不超过75 mg/d。试验组给予大剂量美托洛尔,在服用剂量≥50mg/d后,每日增加25mg/d,维持剂量100~150mg,最大剂量不超过150mg/d。分别于治疗前及治疗后12周比较两组患者临床效果和血压,彩色多普勒超声检测左室射血分数、左室舒张和收缩末期容积。结果两组患者治疗后心功能分级(NYHA分级)均不同程度改善,6分钟步行距离明显增加,收缩压和舒张压明显下降;但试验组改善幅度显著优于对照组(P<0.05)。试验组患者治疗后左室射血分数、左室舒张和收缩末期容积改善程度优于对照组(P<0.05)。两组患者对不同剂量美托洛尔均耐受良好,无中止治疗或出现严重并发症。结论对于慢性充血性心力衰竭,较大剂量美托洛尔更有助于改善心脏功能,并具有较好的治疗安全性。
Objective To study the clinical effects of different doses of metoprolol in the treatment of chronic congestive heart failure. Methods Fifty-six patients with chronic congestive heart failure admitted to the First Affiliated Hospital of Zhengzhou University were selected as the control group and 50 patients admitted to the same hospital as the experimental group. After the two groups of patients were admitted to cardiac, diuretic and vasodilators and other conventional drug treatment. On this basis, the control group was given low dose metoprolol, starting dose of 6.25 ~ 12.5 mg / d, maintenance dose of 25 ~ 75 mg / d, the maximum dose of not more than 75 mg / d. The test group was given high-dose metoprolol, after taking the dose ≥50mg / d, the daily increase of 25mg / d, the maintenance dose of 100 ~ 150mg, the maximum dose of not more than 150mg / d. The clinical effects and blood pressure were compared before and 12 weeks after treatment. Left ventricular ejection fraction, left ventricular diastolic and end-systolic volume were measured by color Doppler sonography. Results After treatment, the NYHA classification of NYHA classification improved to some extent, the distance of 6 minutes increased significantly, and the systolic and diastolic blood pressure decreased significantly. However, the improvement rate of the experimental group was significantly better than that of the control group (P <0.05). After treatment, left ventricular ejection fraction, left ventricular diastolic and end-systolic volume in treatment group were better than those in control group (P <0.05). Both groups were well tolerated with different doses of metoprolol without discontinuation of treatment or with serious complications. Conclusion For patients with chronic congestive heart failure, higher doses of metoprolol may be more helpful to improve cardiac function and have better therapeutic safety.