比索洛尔和Сarvedilol对慢性心力衰竭患者调节适应状态和左心室分数的影响

V. G. Tregubov, P. V. Khilkevich, I. Z. Shubitidze, V. M. Pokrovsky
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摘要

目标。探讨比索洛尔或卡维地洛治疗对慢性心力衰竭(CHF)患者调节适应状态(RAS)及左心室(LV)保留射血分数(pEF)的影响。材料和方法。研究纳入68例左室CHF和pEF患者,随机分为两组,分别给予比索洛尔(7,3±2,4 mg/天,n=34)和卡维地洛(28,4±12,3 mg/天,n=34)治疗。作为联合治疗的一部分,喹普利(13,5±2,5 mg/天,n=34和12,6±2,9 mg/天,n=34),如果有指征-阿托伐他汀(16,3±5,0 mg/天,n=11和15,5±5,2 mg/天,n=11)和肠溶壳乙酰水杨酸(93,8±17,7 mg/天,n=8和94,4±15,8 mg/天,n=8)。治疗初期和治疗6个月后进行:RAS定量评估(心呼吸同步)、跑步机试验、6分钟步行试验、主观生活质量评估、脑利钠肽n端片段水平测定、超声心动图检查、每日血压监测。两种联合药物治疗方案具有相当的心脏保护、降压和神经调节作用,同样增加了运动耐受性。与比索洛尔相比,卡维地洛对RAS的积极影响不同,更能改善患者的生活质量。在合并CHF和pEF的LV患者中,与比索洛尔相比,卡维地洛可能更可取,因为它对RAS有积极作用。
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DETERMINATION OF THE IMPACT OF BISOPROLOL AND СARVEDILOL ON REGULATORY-ADAPTIVE STATUS OF PATIENTS WITH CHRONIC HEART FAILURE AND PRESERVED LEFT VENTRICULAR FRACTION
Objective. To determine the effect of bisoprolol or carvedilol therapy on the regulatory-adaptive status (RAS) of patients with chronic heart failure (CHF) and preserved ejection fraction (pEF) of the left ventricle (LV) the background of hypertensive disease (HD).Material and methods. The study involved 68 patients with CHF and pEF of the LV, who were randomized into two groups for treatment with bisoprolol (7,3±2,4 mg/day, n=34) and carvedilol (28,4±12,3 mg/day, n=34). As part of the combination therapy, quinapril was prescribed (13,5±2,5 mg/ day, n=34 and 12,6±2,9 mg/day, n=34), and if indicated – atorvastatin (16,3±5,0 mg/day, n=11 and 15,5±5,2 mg/day, n=11) and acetylsalicylic acid in the intestinal soluble shell (93,8±17,7 mg/day, n=8 and 94,4±15,8 mg/day, n=8), respectively. Initially and after 6 months of therapy were carried out: quantitative assessment of RAS (by means of a sample of cardiac-respiratory synchronism), treadmill test, six-minute walking test, subjective assessment of quality of life, determination of the level of N-terminal fragment of brain natriuretic peptide, echocardioscopy, daily monitoring of blood pressure.Results. Both regimens of combined drug therapy had comparable cardioprotective, hypotensive and neuromodulating effects, equally increased exercise tolerance. In comparison with bisoprolol, carvedilol differed positive impact on RAS, improved quality of life more.Conclusion. In patients with CHF and pEF LV in combination therapy, the use of carvedilol, in comparison with bisoprolol, may be preferable due to the positive effect on the RAS.
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