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 mmHg(1 mmHg=0.133kPa),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 curative effect of benazepril in different doses in treatment of chronic congestive heart failure (CHF).Methods CHF patients with disease course from 3 y to 15 y (n=240, male 126, female 114, aged from 60 to 81 and average age=73.40±6.35) were chosen from Mar. 2013 to May 2015. The patients were randomly divided into group A (n=76), group B (n=86) and group C (n=78), and the comparison in basic diseases, cause, age, sex and heart function had no statistical difference among 3 groups (all P>0.05). Besides of basic therapy, group A were given benazepril (5 mg, qd), group B, (10 mg, qd) and group C (20 mg, qd). After treatment for 12 m, the curative effect was reviewed and adverse reactions were recorded. The levels of left ventricular ejection fraction (LVEF), left ventricular end-diastolic inner diameter (LVEDd), left ventricular end-systolic diameter (LVESd), 6-minute walk test (6MWT) and brain natriuretic peptide (BNP) were detected before and after treatment.Results The total effective rate was 80.2% in group A, 87.2% in group B and 96.1% in group C, which was higher in group C than that in group A and group B (all P<0.05). LVEDd, LVESd and LVEF were improved in 3 groups after treatment (all P<0.05). Compared with group A and group B, the improvements of LVEDd, LVESd and LVEF were more significant in group C (all P<0.05). The level of BNP decreased and 6MWT increased in 3 groups after treatment (all P<0.05). The level of BNP decreased and 6MWT increased in group C compared with group A and group B after treatment (all P<0.05). Conclusion Benazepril in dose of 20 mg has higher curative effect than that in dose of 5 mg and that in 10 mg on CHF, and can improve more effectively heart function with higher safety.