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目的观察不同剂量贝那普利治疗慢性充血性心力衰竭(CHF)的疗效。方法入选2013年3月至2015年5月在河北医科大学哈励逊国际和平医院门诊就医的轻中度CHF患者240例,其中男126例,女114例,年龄60~81岁,平均(73.40±6.35)岁,病程3~15年。按照随机对照的原则分为A组(76例)、B组(86例)、C组(78例)三个治疗组。三组间基础疾病、诱因、年龄、性别及心功能状况等临床资料比较,差异无统计学意义(P均>0.05),具有可比性。三组患者均进行基础治疗。同时A组给予贝那普利5 mg,1/日;B组给予贝那普利10 mg,1/日,观察3周后若收缩压>90 mm Hg(1mm Hg=0.133k Pa),未发生低血压,血肌酐升高不超过50%基线水平,则继续治疗;如果患者不耐受,贝那普利可恢复至5 mg治疗;C组给予贝那普利20 mg,1/日,同时观察患者耐受情况。连续治疗12个月后进行疗效评估和记录不良反应。治疗前后测定左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD),6 min步行试验距离和脑钠肽(BNP)水平。结果 A组患者总有效率为80.2%,B组为87.2%,C组为96.1%。总有效率C组较A组和B组升高,差异有统计学意义(P均<0.05)。与治疗前比较,三组患者治疗后LVEDD、LVESD、LVEF均改善,差异有统计学意义(P均<0.05)。与A组和B组比较,C组LVEDD、LVESD、LVEF指标改善更明显,差异有统计学意义(P均<0.05)。与治疗前比较,三组治疗后BNP水平下降,6 min步行距离增加,差异有统计学意义(P均<0.05)。与A组和B组治疗后比较,C组BNP水平下降,6 min步行距离增加,差异有统计学意义(P均<0.05)。结论贝那普利20 mg较5 mg和10 mg治疗慢性充血性心力衰竭更有效,更有效地改善心功能,安全性较好。
Objective To observe the effects of different doses of benazepril on chronic congestive heart failure (CHF). Methods From March 2013 to May 2015, 240 patients with mild-to-moderate CHF were enrolled at the Hailun Sun International Peace Hospital in Hebei Medical University from March 2013 to May 2015. There were 126 males and 114 females, aged from 60 to 81 years, with an average of 73.40 ± 6.35) years old, duration of 3 to 15 years. According to the principle of randomized control, the patients were divided into three groups: group A (76 cases), group B (86 cases) and group C (78 cases). There was no significant difference between the three groups in clinical data such as underlying diseases, predisposition, age, gender and cardiac function (all P> 0.05). Three groups of patients underwent basic treatment. Group A received benazepril 10 mg once a day for 3 weeks. If systolic blood pressure was> 90 mm Hg (1 mm Hg = 0.133 kPa) after 3 weeks of observation, no low If blood pressure and serum creatinine did not rise above 50% of the baseline level, treatment was continued; benazepril recovered to 5 mg if the patient was intolerant; and group C received benazepril 20 mg once daily Patient tolerance. After 12 months of continuous treatment efficacy evaluation and record adverse reactions. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end systolic diameter (LVESD) were measured before and after treatment. The distance of 6-min walking test and the level of BNP were measured. Results The total effective rate in group A was 80.2%, in group B 87.2% and in group C 96.1%. The total effective C group than the A and B group increased, the difference was statistically significant (P all <0.05). Compared with those before treatment, the LVEDD, LVESD and LVEF of the three groups improved after treatment, the difference was statistically significant (all P <0.05). Compared with group A and group B, the indexes of LVEDD, LVESD and LVEF in group C improved more obviously, the difference was statistically significant (all P <0.05). Compared with those before treatment, the level of BNP in the three groups decreased and the walking distance increased in 6 min after treatment, the difference was statistically significant (all P <0.05). Compared with group A and group B, the level of BNP in group C decreased and the distance of walking increased in 6 min (P <0.05). Conclusion Benapril 20 mg is more effective than 5 mg and 10 mg in the treatment of chronic congestive heart failure, and more effective in improving cardiac function and safety.