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目的:比较两种剂量福辛普利治疗重症心力衰竭(HF)的临床疗效、安全性和防治心血管事件的作用。方法:将85例NYHA心功能Ⅲ、Ⅳ级重症HF患者随机单盲分为2组:福辛普利20mg/d组43例;福辛普利10mg/d组42例,治疗1年,观察患者心功能、不良反应和心脏性事件发生情况。结果:福辛普利治疗重症HF 3、12个月,2组均能明显改善心功能,包括临床症状改善总有效率,超声心动图左心室射血分数(LVEF)、左心室短轴缩短率(FS)、二尖瓣快速充盈期和心房收缩期二尖瓣血流速度(E/A),也能降低纤溶系统的纤溶酶原激活物抑制剂-1(PAI-1)、纤维蛋白原(FG)、C-反应蛋白(CRP)、且20mg/d组对上述指标改善均优于10mg/d组,(P<0.05),同时20mg/d组治疗3,12个月发生不稳定型心绞痛(UP),心律失常事件比10mg/d组明显减少(P<0.05),而2组治疗后3,12个月血压及心率均较治疗前明显下降(P<0.05),但无组间差异(P<0.05),2组不良反应轻微。结论:用福辛普利20mg/d治疗重症HF,预防心脏性事件较合适,需否用40mg 1次/d,仍需临床探讨。
Objective: To compare the clinical efficacy, safety and prevention and treatment of cardiovascular events in two doses of fosinopril in patients with severe heart failure (HF). Methods: Eighty-five patients with NYHA cardiac function grade Ⅲ and Ⅳ severe HF were randomly divided into two groups: fosinopril 20 mg / d group, 43 patients and fosinopril 10 mg / d group, 42 patients for one year. Patients with cardiac function, adverse reactions and cardiac events. Results: Fosinopril treatment of severe HF 3, 12 months, two groups were significantly improved cardiac function, including the total effective rate of clinical symptoms, echocardiography left ventricular ejection fraction (LVEF), shortening of left ventricular short axis (FS), rapid filling of the mitral valve, and atrial systolic mitral flow velocity (E / A) also decreased plasminogen activator inhibitor-1 (PAI-1) (FG), C-reactive protein (CRP), and 20mg / d group were better than the above 10mg / d group, (P <0.05), while 20mg / d group 3,12,12 months of treatment does not occur Stable angina pectoris (UP) and arrhythmia events were significantly lower than those of 10 mg / d group (P <0.05), while the blood pressure and heart rate of 3 and 12 months after treatment in both groups were significantly lower than those before treatment (P <0.05), but none There was no significant difference between the two groups (P <0.05). The adverse reactions in the two groups were slight. Conclusion: Fosinopril 20mg / d treatment of severe HF, the prevention of cardiac events more appropriate, need to use 40mg 1 / d, still need clinical study.