目的 探討美托洛爾治療風(fēng)濕性心臟病慢性心力衰竭的臨床療效。方法 選擇2013年4月—2014年4月濱?？h人民醫(yī)院收治的風(fēng)濕性心臟病慢性心力衰竭患者80例, 隨機分為治療組和對照組, 每組40例。對照組患者入院后給予常規(guī)對癥治療, 同時口服馬來酸依那普利片和螺內(nèi)酯片。治療組患者在對照組治療基礎(chǔ)上口服酒石酸美托洛爾片, 起初劑量6.25 mg/次, 2次/d, 以后視臨床情況每兩周增加劑量至100 mg/次, 2次/d。兩組均連續(xù)治療3個月。比較兩組的臨床療效, 同時檢測兩組治療前后左室舒張末內(nèi)徑(LVEED)、左室收縮末內(nèi)徑(LVESD)、左房內(nèi)徑(LADD)、左心射血分?jǐn)?shù)(LVEF)、舒張壓、心率、心胸比及NYHA分級的變化。結(jié)果 對照組和治療組總有效率分別為82.5%、92.5%, 兩組比較差異有統(tǒng)計學(xué)意義(P<0.05)。治療后, 兩組患者的LVEED、LVESD、LADD均較治療前顯著降低, LVEF顯著升高, 同組治療前后差異有統(tǒng)計學(xué)意義(P<0.05);治療后, 治療組的心功能指標(biāo)改善程度優(yōu)于對照組, 兩組比較差異有統(tǒng)計學(xué)意義(P<0.05)。治療后兩組患者的舒張壓、心率及心胸比較治療前明顯降低, 同組治療前后差異有統(tǒng)計學(xué)意義(P<0.05);治療后, 治療組這些指標(biāo)改善程度優(yōu)于對照組, 兩組比較差異有統(tǒng)計學(xué)意義(P<0.05)。治療后, 治療組患者的NYHA分級較治療前明顯降低, 且治療組低于對照組, 差異有統(tǒng)計學(xué)意義(P<0.05)。結(jié)論 美托洛爾聯(lián)合常規(guī)療法治療風(fēng)濕性心臟病慢性心力衰竭具有較好的臨床療效, 可有效改善患者的心功能, 降低NYHA分級, 具有一定的臨床應(yīng)用價值。

Objective To investigate the clinical effect of metoprolol in treatment of rheumatic heart disease with chronic heart failure. Methods The patients with rheumatic heart disease with chronic heart failure (80 cases) of People's Hospital of Binhai County from April 2013 to April 2014 were randomly divided into treatment and control groups, and each group had 40 cases. The patients in the control group were given conventional symptomatic treatment. At the same time, they were po administered with Enalapril Maleate Tablets and Spironolactone Tablets. The patients in the treatment group were po administered with Metoprolol Tartrate Tablets, and the first dosage of 6.25 mg/time, twice daily. The dosage was increased every two weeks according to the clinical situation till 100 mg/time, twice daily. Each group was treated for three months. After treatment, the efficacy was evaluated, while the changes of LVEED, LVESD, LADD, LVEF, diastolic blood pressure, heart rate, cardio-thoracic ratio (CTR) and NYHA classification were detected. Results The efficacies in the control and treatment groups were 82.5% and 92.5%, respectively, and there were differences between the two groups (P < 0.05). After treatment, LVEED, LVESD, and LADD in two groups were significantly reduced, LVEF increased significantly, and the difference was statistically significant in the same group before and after treatment (P < 0.05). After treatment, cardiac function indexes in the treatment group improved better than those in the control group, and there were differences between two groups (P < 0.05). After treatment, diastolic blood pressure, heart rate, and CTR were significantly reduced, and the difference was statistically significant in the same group before and after treatment (P < 0.05). After treatment, obvervational indexes in the treatment group improved better than those in the control group, and there were differences between two groups (P < 0.05). After treatment, NYHA classification in the treatment group decreased significantly, and the treatment group was lower than that in the control group, with significant difference between two groups (P < 0.05). Conclusion Metoprolol combined with conventional therapy has the good clinical effect in treatment of rheumatic heart disease with chronic heart failure, and can effectively improve the heart function, can reduce the NYHA classification, which has a certain clinical value.