【摘要】 目的 :评价血管紧张素Ⅱ受体拮抗剂、血管紧张素转换酶抑制剂 (ACEI)及两者合用治疗充血性心力衰竭的临床效果。 方法 :6 0例患者随机分为卡托普利组、氯沙坦组和联合用药组 ,于入院时行NYHA心功能分级 ,超声心动图测定左室射血分数 (LVEF)、左室收缩末容积 (LVESV)、左室舒张末容积 (LVEDV) ,治疗 1、3、6、12个月复查上述指标。 结果 :卡托普利组与联合用药组治疗 1个月时心功能、LVESV、LVEDV、LVEF值均有显著改善 ,优于氯沙坦组 ,卡托普利组LVEF和LVESV有随着服药时间的延长进一步好转的趋势 ,联合用药组用药 3个月后各项指标处于稳定状态 ,氯沙坦组服药 3个月各项指标才开始发生变化 ,服药 3、6、12个月 3组间比较差异无统计学意义。 结论 :血管紧张素Ⅱ受体拮抗剂与ACEI均可逆转左心室重塑和防治心力衰竭 ,在心力衰竭的长期治疗中可获得相同的益处 ,但心力衰竭急性期宜选用ACEI ,可尽快改善临床症状 ,联合应用两种药物并未显示出叠加的优势且增加了患者的经济负担。更多还原

【Abstract】 Objective: To compare the effect of angiotensin Ⅱ antagonist (AngⅡA) losartan with angiotensin converting enzyme inhibitors (ACEI) captopril and the combination of the two agents on congestive heart failure. Methods: Sixty patients with ischemic cardiomyopathy or dilated cardiomyopathy are randomly divided into 3 groups: captopril group, losartan group, combination group. Clinical parameters, including heart function, assessed by NYHA, and LVEF, LVESV, LVEDV, measured by echocardiography, are recorded at the beginning and 1,3,6,12 months after therapy. Results: The parameters after treatment were respectively different from those before. Heart function, LVESV, LVEDV, LVEF of the captopril group or combination group have improved obviously after 1 month therapy compared with those of losartan group. LVEF and LVESV of captopril group show the trend of increase with prolongation of treatment. The parameters of combination group show the tendancy of stable after 3 months. The parameters of losartan group increased significantly in 3 months than before. The change of the three groups have no statistically significant in 3?6?12 month. Conclusion: Both angiotensin Ⅱ antagonist (AngⅡA) and angiotensin coverting enzyme inhibitors(ACEI) can reverse the myocardial remodeling, prevent the progress of heart failure and improve the heart function. They have equal effect on long term treatment of heart failure. But in acute period, ACEI is better than losartan because it can immediately improve the symptom. The combination of two agents hasn’t shown the benefit and increase the financial burden of the patients.更多还原