作者:赵辉 寇建会 黄秀英 南海燕 郑岭书 吴欣 【关键词】 充血性心力衰竭;运动耐量;卡维地洛;最大摄氧量;无氧阈;运动心肺功能检测 [摘要] 目的 探讨非选择性β受体阻滞剂治疗充血性心力衰竭对运动耐量的影响。方法 选择近期诊断充血性心力衰竭患者共160例,根据年龄、性别、心功能随机分为两组,每组各80例。其中观察组在常规治疗的基础上加用卡维地洛(carvedilol),对照组仅采用常规治疗。分别于治疗前和治疗6个月后行运动心肺功能检测,检测气体代谢及做功指标。同时记录受试者的症状、体征及心功能分级。结果 观察组心衰复发住院率明显低于对照组(6.67%∶27.59%)。观察组与对照组比较最大摄氧量(VO2max)增大(P<0.05);无氧阈(AT)增高(P<0.05);通气量(VE)增高(P<0.05);通气量(VE)/摄氧量(VO2)增高(P<0.05);氧脉搏(O2Pulse)明显增高(P<0.05);最大心率增高(P<0.05);最大心率增值明显增高(P<0.05);运动时间延长(P<0.05);最大做功量(Wmax)增高(P<0.05);New York心功能分级平均改善0.5级;症状和体征改善(P<0.05)。结论 充血性心力衰竭患者长期服用非选择性β受体阻滞剂能够通过改善心功能增加运动耐量。 [Abstract] Objective This article discusses the effect of non-choice β receptor blocked on exercise tolerace when it is used to treat congestive heart failure(CHF).Methods 160 patients were enrolled who with CHF and NYHA heart function class Ⅰ to Ⅲ degree grade.The patients were divided into two groups at random according to their age,sex,and pump function.There were 80 patients in each group.Observing groups had a Carvedilol on the basis of the routine treatment;control group only received the routine treatment.The patients of the two groups should have been examined with cardiopulmonary exercise test respectively six months before and after the treatment.Afterwards,we evaluated gas metabolism or work index.At the same time,we recorded the examinees' symptom,physical sign and pump function grade.Results During the experiment two patients died,difference from observing group and control group each.Observing groups were apparently lower than control group in heart failure recurrence admission rate(6.67%∶27.59%).Compared with control group,maximal oxygen uptake had obviously rised (P<0.05)in observing groups;anaerobic threshold had increased (P<0.05);ventilate capacity increased (P<0.05);ventilate capacity/oxygen uptake increased (P<0.05);oxygen pulse had improved (P<0.05);maximal heart rate rised (P<0.05);maximal heart rate increment increased (P<0.05);exercise time extensed (P<0.05);maximal work had improved (P<0.05);maximal work increased (P<0.05);and NYHA heart function grade had enhanced 0.5 grade on average.Symptom and physical sign had improved (P<0.05).Conclusion CHF patients could improve heart function and increase exercise tolerace by having a non-choice β receptor blocked long time. [Key words] congestive heart failure;exercise tolerance;carvedilol;maximal oxygen uptake;anaerobic threshold;cardiopulmonary exercise test 1 资料与方法 1.1 材料 卡维地洛(carvedilol),商品名为达利全,上海罗氏制药有限公司生产;主要仪器为美国PHYSIO-DYNE公司生产的MAX-Ⅱ心肺功能测试系统。 1.2 研究对象 选择于2004年11月~2006年9月在保定市第一医院门诊或住院治疗的充血性心力衰竭患者160例。所有病例均符合Framingham充血性心力衰竭诊断标准[4,5],心功能分级均在Ⅱ~Ⅲ级,所有病例根据年龄、性别、心功能分级被随机分成两个组(按随机数字排列表)。治疗前观察组、对照组之间比较,其年龄、性别、心功能方面均衡性良好(P>0.05),治疗前两组之间的年龄、性别、心功能及各项气体代谢及做功指标方面差异均无显著性(P>0.05),两组之间具有可比性。(1)对照组:80例,男41例,女39例,年龄56~72岁,平均(62.26±7.81)岁。心功能分级,Ⅱ级46例,Ⅲ级34例。(2)观察组:80例,男43例,女37例,年龄55~73岁,平均(63.37±8.35)岁。心功能分级,Ⅱ级45例,Ⅲ级35例。以上两组所有病例中,缺血心肌病88例,高血压心脏病57例,特发性扩张型心肌病15例。 1.3 研究方法 1.3.1 治疗方法 对照组:采用CHF常规治疗,如利尿剂、强心苷、β-肾上腺素能拮抗剂、血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂等。观察组:在上述常规治疗的基础上,加用carvedilol 3.125~25 mg,每日2次,连续用6个月。 1.3.2 观察指标和方法 心衰症候群、心功能分级、气体代谢及运动指标:分别于治疗前和治疗6个月后采集上述指标。 1.3.2.1 心衰症候群 我们选择的心衰症候群包括:夜间阵发性呼吸困难、颈静脉怒张、肺部音、颈静脉返流征阳性、第三心音奔马律为主项;肝肿大、踝部水肿为次项。 1.3.2.2 心功能分级 应用美国纽约心脏病学会(NYHA)分级法[6]。 1.3.2.3 气体代谢及运动指标 最大摄氧量(VD2max)、无氧阈(AT)、通气量(VE)、通气量(VE)/摄氧量(VO2)、氧脉搏(O2Pulse)、最大心率(HRmax)、最大心率增值(ΔHRmax)、运动时间(ET)、最大做功量(Wmax)。 1.4 统计学方法 计量资料用均数±标准差(x±s)表示。观察组、对照组两组间两两比较采用方差分析,各组治疗前后的比较用配对设计的差值均数与总体均数比较的t检验,观察组与对照组疗效比较采用Ridit分析。 2 结果 |