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目的 评价大剂量西拉普利在慢性心力衰竭 (CHF)患者中应用的安全性及疗效。方法 10 3例CHF患者 (男 83例 ,女 2 0例 ) ,平均年龄 5 9岁 ,心功能Ⅱ Ⅳ级 ,左室射血分数 (LVEF) 35 %。从小剂量开始使用 ,只要能耐受 ,尽可能递增到 5～ 7 5mg d ,治疗中严密监测各项相关指标。结果 平均随访时间近 2 0周 ,随访期间死亡 5例 ,其中心性死亡 4例 ,非心性死亡 1例 ,2例因心力衰竭加重而再次住院。治疗后心功能和 6min步行距离较治疗前明显改善 [( 2 0 4± 0 6 6 )比 ( 3 0 5± 0 6 5 )和( 310 2 9± 180 14)m比 ( 2 0 0 87± 175 97)m ,P <0 0 0 1],超声心动图检查示左室舒张末径 (LVEDD)和收缩末径 (LVESD)减小 [( 6 1 17± 9 90 )mm比 ( 6 3 86± 10 2 0 )mm和 ( 47 2 4± 11 0 2 )mm比 ( 5 1 4 9±11 0 7)mm ,P <0 0 0 1],LVEF明显增加 [( 34 82± 8 14) %比 ( 43 78± 10 37) % ,P <0 0 0 1]。本组患者治疗后血压略有下降 ,血钾略升高 ,但均在正常范围内 ,血肌酐无明显变化。非缺血性心脏病组与缺血性心脏病组比较 ,LVESD变化率和LVEF变化率差异有显著性 [( 9 13± 12 72 ) %比 ( 4 38±10 39) % ,( 39 6 9± 42 11) %比 ( 2 0 97± 2 2 84) % ,P <0 0 5和 0 0 1]。结论 大剂量应
Objective To evaluate the safety and efficacy of high-dose cilazapril in patients with chronic heart failure (CHF). Methods Totally 83 CHF patients (83 males and 20 females) were enrolled. The mean age was 49 years. The cardiac function was grade IV and the left ventricular ejection fraction (LVEF) was 35%. Starting from a small dose, as long as able to tolerate, as much as possible increased to 5 ~ 7 5mg d, the treatment of closely monitoring the relevant indicators. Results The average follow-up time was 20 weeks. Five patients died during follow-up. Four patients died of central death and one patient died of non-cardiac death. Two patients were hospitalized again due to worsening of heart failure. After treatment, heart function and walking distance 6 min were significantly improved compared with those before treatment [((204 ± 0 6 6) vs (305 ± 6 65) and (310 2 9 ± 180 14) m (2 0 87 ± 175 97) m, P 0 01 0). Echocardiography showed a decrease in left ventricular diastolic diameter (LVEDD) and end systolic diameter (LVESD) of 6 1 17 ± 9 90 mm (6 3 86) LVEF increased significantly (34 82 ± 8 14)% compared with that of the control group (P <0.05), and the ratio of (47 2 4 ± 1 0 2) mm and (51 4 9 ± 1 0 7) mm, P 0 01 0, (43 78 ± 10 37)%, P <0 0 0 1]. The treatment of patients with a slight decline in blood pressure, blood potassium slightly increased, but were within the normal range, no significant changes in serum creatinine. There were significant differences in the rate of change of LVESD and rate of change of LVEF between non-ischemic heart disease group and ischemic heart disease group (9 13 ± 12 72% vs 4 38 ± 10 39%, 39 69 ± 42 11)% (2 0 97 ± 2 2 84)%, P 0 05 and 0 0 1]. Conclusion high-dose should be