【作者】 郑雁；

【导师】 董均树；

【作者基本信息】 吉林大学 ， 临床医学， 2007， 硕士

【摘要】 为了明确卡维地洛对老年舒张性心力衰竭(Diastolic heart failure,DHF)患者心功能及糖脂代谢的影响,本文对2006年2月-2007年1月在我科就诊并诊断为舒张性心力衰竭的老年患者(年龄在60岁以上)76例,随机分成治疗组和对照组进行了回顾性研究。观察两组治疗前后患者临床症状、反映舒张功能的指标的改变及血糖、血脂代谢的改变。结果发现:治疗组患者在治疗后临床症状获得改善(P<0.05),左室舒张功能指标亦优于治疗前,对照组亦有一定改善,而治疗组与对照组相比差异有显著性。治疗组用药前后血糖、血脂变化无显著性差异,与对照组相比差异具有显著性。治疗过程中,两组均未发生明显不良反应,无一例停药。本研究结果表明:应用卡维地洛可改善老年舒张性心力衰竭患者的左室功能,且对糖脂代谢无不良影响。更多还原

【Abstract】 Accompany to the population aging, the morbidity of elder heart failure increased gradually. But diastole dysfunction is the first symptom in the early stage of heart failure, it appeared as diastolic heart failure. There is one percent three of diastolic heart failure in the chronic heart failure. There are many reports ofβ-adrenal receptor blocker be used in congestive cardiac failure before, but there less reports of nonselectiveβ-adrenal receptor blocker be used in diastolic heart failure. So our study is to treat diastolic heart failure with Carvedilol which is nonselectiveβ-adrenal receptor blocker, then observe the change of heart function and glucolipometabolic of the patients. We chose 76 patients (all older than 60) who visit our department from Feb 2006 to Jar 2007, diagnosed as diastolic heart failure which depended on the denominator revised by Chinese heart failure institution. To divide the patients into two parts stochastic,one part contains 34 patients is treated group , the other contains 42 patients is control group, they all be given routine treatment of diastolic heart failure , include diuretic agent, vasodilator agent, angiotensin-converting enzyme inhibitor, digitalis of small dosage, the treated group give carvediol in addition( from little dose to more ), first give 3.125mg twice a day for 7 to 14 days, then observe the blood pressure and heart rate , if the blood pressure and heart rate didn’t lower then normal, and there is no atrioventricular conduction blocker increase the dosage to 6.25mg twice a day, and then to increase gradually per 7 to 14 days until get 25mg as the target dosage , the course of treatment is 3-6 month. During the course observe the change of symptom, test the blood pressure, take electrocardiogram, and also observe the adverse reaction. To determine the parameter of the diastolic function of heart , such as early diastolic filling time, atrial contraction time , E/A, isovolumic relaxation time (IVRT), left atrial dimension (LAD), stroke volume (SV), acceleration index (ACI), systemic vascular resistance (SVR), thoracic fluid content (TFC), left ventricular ejection fraction (LVEF), before and after treatment of two groups by ultrasonic cardiogram and uninjured cardio dynamic machine , then compare the results . And also compare the change of glucolipometabolic. The study is a retrospective study.Result: 1、There is significance difficult in therapeutic effect between the treated group and the control group (p<0.05); 2、After treatment the clinical symptom of the treated group has been improved ( p<0.05),the control group also has been improved , there has significance difficult between the two groups; 3、There has no significance difficult of glucose and lipid between before and after treatment in treated group. But there has significance difficult between the two groups. During the treatment there has no significance adverse effect in the two groups, non stop treatment.Conclusion: 1、Carvedilol could improve the function of left ventricular of elder diastolic heart failure . The mechanism is:①It could depress the left ventricular end-diastolic volume, depress the myocardial volume of oxygen by its negative isotropic effect, so it could improve heart muscle ischemia and ventricular diastole function. In addition, the function of it such as negative chronotropic effect could prolong the diastolic time, improve engorge of left ventricular and increase the volume of end-diastole;②It could active suppression the activity of sympathetic, block the increase of tension of adrenaline in heart, block the toxic effect to heart by catecholamine, inhibit the apoptosis of cadiocyte, block and reverse the reconstitution of ventricles by the blockage ofβ1、β2-recepter;③It could depress peripheral resistance by block theα1-recepter; it also could dilate the coronary artery, increase the blood supply. In addition it could neutralize myocardium inhibitory action induced by the block ofβ-receptor;④It has the effect of antioxidation, and it could eliminate oxygen free radical in body and the distinct protection of blood vessel;⑤It has the function of anti-tachyarrhythmia, so it could depress the tachyarrhythmia. In addition, there is no significant difference in LAD and ACI, it may related to the short obverse time. 2、It has no significance effect on the metabolic of glucose and lipid which is similar with the study by Jacob. 3、The patients of treatment group had no obviously complaint during the course. Most of the patients could tolerance the target dosage. There is two patient got lower heart rate (lower than 55) before get the target dosage, but they all tolerate the therapy dosage maintained. So to use Carvedilol is safe. 4、The mechanism of uninjured cardiodynamics machine is dependent on impedance measurement of electrobiology of the thorax. It could calculus the stroke volume, cardiac output and other haemodynamics parameters, so the condition of haemodynamics and the ventricular function could be evaluated. This method is safe and easy. There are some studies in abroad confirm that the results are accurate and reliability now.In short, Carvedilol could improve the function of left ventricular of elder diastolic heart failure , and has no significance effect on the metabolic of glucose and lipid. But the study only observe the short effect, is lack of large-scale clinical trial, is waiting for further study.更多还原