【摘要】 应用洋地黄及渐增量襻利尿剂治疗无效的４３例严重充血性心力衰竭（ＣＨＦ）病人，加用卡托普利治疗１周，其中１１例（２６％）心功能改善（Ａ组）；其余３２例无效病人，再加用氨体舒通治疗１０天，其中２５例疗效满意（７８％）（Ｂ组），７例无效（Ｃ组）。三组病人基础血浆肾素活性均明显增高，但相互之间无明显差异；血管紧张素Ⅱ在Ｃ组极度增高，且与其它两组比较差异有显著性（Ｐ均＜０．０５）；血浆醛固酮水平在Ｃ组最高，Ａ组最低（Ｐ均＜０．０５）。血浆醛固酮水平与２４小时尿Ｎａ＋／Ｋ＋比值呈负相关（ｒ＝－０．６８，Ｐ＝０．００４６）。治疗期间高血钾和氮质血症均未发生。提示严重ＣＨＦ的合理治疗应包括洋地黄、利尿剂、必要时加抗醛固酮药物，２４小时尿Ｎａ＋／Ｋ＋比值可作为抗醛固酮治疗的重要指标。更多还原

【Abstract】 Theeficacyandsafetyofantialdosteronetherapyin43patientswithseverechroniccongestiveheartfailure(CHF)refractorytotreatmentwithdigitalisandhighdosesofloopdiureticswereevaluated.Captoprilwasaddedtoeachpatient′sregimen.Bytheendofthefirstweekofcapto-priladministration,elevenpatients(26%)showedagrossnatriuresisandreductioninexcessweight≥25%(groupA).Theremaining32patientswithinsuficientresponsessubsequentlyreceived60-120mgspironolactoneperdayfor10days.Spironolactonecoadministrationwashighlyefectivein25of32patients(78%)(groupB).MarkednatriuresisanddiuresiswereachievedandCHFsymptomsregressedordisappeared.Theremaining7patientshadnoresponsetothistherapy(groupC).Plas-mareninactivitywasalhighlyelevatedandnotsignificantlydiferentbetweenthethreegroups.An-giotensinⅡlevelswereextremelyhighinthegroupCandsignificantlydiferentfromtheothergroups(P<0.05,respectively).Plasmaaldosteronevaluesdiferedsignificantlybetweenthe3groups.HighestvalueswerefoundingroupCandlowestvaluesingroupA(P<0.05,respectively).Thecorelationcoeficientbetween24-hoururinaryNa+/K+ratiosandplasmaaldos-teroneconcentrationswas-0.68(P=0.0046).Hyperkalemiaandazotemiadidnotoccurinalpa-tientsduringtheperiodoftreatment.TheresultssuggestthatrationaltherapyforsevereCHFin-cludingadditionofantialdosteronedrugstodiureticsanddigitalismightbehelpful.TheurinaryNa+/K+ratioappearstobeausefulindicatorforadministeringantialdosteronedrugs.更多还原