| 摘要: |
| ［摘要］ 目的 观察卡维地洛（carvedilol)治疗儿童慢性充血性心力衰竭的临床疗效，探讨治疗剂量及安全性，同时对比观察与美托洛尔（metoprolol）临床疗效的不同。方法 将90例慢性充血性心力衰竭患儿随机分为常规组（30例）、美托洛尔组（28例）和卡维地洛组（32例)，均给予常规抗心力衰竭治疗（洋地黄、利尿剂、血管扩张药），美托洛尔组在常规治疗基础上同时加用美托洛尔治疗，卡维地洛组在常规治疗基础上同时加用卡维地洛治疗。治疗前和治疗后6个月记录三组患儿心率变化，X线胸片测心胸比率（CTR)，彩色多普勒超声仪测心脏左室射血分数（LVEF)、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左室收缩末期内径(left ventricular end systolic diameter,LVESD)，酶联免疫吸附试验（ELISA）进行定量检测血浆脑利钠肽（B-type natriuretic peptide,BNP）。观察患儿临床症状、心功能的改善以及对卡维地洛的耐受量及不良反应。结果 （1）美托洛尔组和卡维地洛组治疗6个月后临床症状改善，心率减慢，CTR降低，心功能级数均有不同程度降低；卡维地洛组降低更为明显，两组比较差异有统计学意义（P<0.01）。常规组治疗后仅轻微改善，差异无统计学意义（P>0.05）。（2）卡维地洛组LVEDD及LVESD明显减小，LVEF明显提高，左心室结构和功能均有明显改善，与美托洛尔组比较差异有统计学意义(P<0.05)。常规组差异无统计学意义（P>0.05）。（3）卡维地洛组治疗后血清BNP下降更明显，与美托洛尔组比较差异有统计学意义（P<0.01）。结论 卡维地洛可以从根本上防止和逆转慢性心力衰竭时的异常神经激素，抑制心肌重塑，使患儿心功能得到明显改善，比美托洛尔疗效更显著，且长期治疗安全有效。 |
| 关键词: 慢性心力衰竭 卡维地洛 美托洛尔 儿童 |
| DOI：10.3969/j.issn.1674-3806.2015.03.09 |
| 分类号:R 541.6+1 |
| 基金项目: |
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| Study on clinical curative effect of carvedilol in the treatment of children with chronic congestive heart failure |
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WANG Li-yan, WANG Wen-di, QIAO Ling-yan, et al.
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The First Department of Internal Medicine, Women and Children Hospital of Qingdao, Shandong 266000, China
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| Abstract: |
| ［Abstract］ Objective To observe the curative effect and target dose and the safety of carvedilol in the treatment of children with chronic congestive heart failure(CHF).Methods Ninety children with CHF were randomly divided into 3 groups:ordinary regimen group(n=30), metoprolol regimen group（n=28) and carvedilol regimen group（n=32). The three groups were treated with routine therapy(diuretic, ACEI or digitalis), treatment groups were treated with carvedilol or metoprolol in addition to routine therapy.The serum levels of BNP were measured by enzyme-linked immune absorbent assay. The heart rate，cardiothoracal ratio(CTR), left ventricular end diastol diameter （LVEDD）, left ventricular end systolic diameter（LVESD） and the left ventricular ejection fraction(LVEF) were measured by X-ray and echocardiogram before and 6 months after treatment.Results （1）After treatment, the clinical symptoms were significantly improved, CTR, heart rate, cardiac function grades decreased, and ejection fraction(EF) was significantly increased showing carvedilol group was superior to metoprolol group(P<0.01).（2）The LVEDD and LVESD were notably decreased after treatment with carvedilol.There were significant difference. Compared with metoprolol group, there was a great significant difference(P<0.05). （3）Plasma concentration of BNP was significantly decreased, carvedilol was more effective than the other two groups（P <0.01）.Conclusion Carvedilol can prevent and reverse the neurohumoral disorders in chronic heart failure and can improve the cardiac function of children with CHF. Carvedilol is effective and safe in the treatment of children with CHF and superior to metoprolol. |
| Key words: Chronic heart failure Carvedilol Metoprolol Children |
