目的 探讨美托洛尔治疗风湿性心脏病慢性心力衰竭的临床疗效。方法 选择2013年4月—2014年4月滨海县人民医院收治的风湿性心脏病慢性心力衰竭患者80例, 随机分为治疗组和对照组, 每组40例。对照组患者入院后给予常规对症治疗, 同时口服马来酸依那普利片和螺内酯片。治疗组患者在对照组治疗基础上口服酒石酸美托洛尔片, 起初剂量6.25 mg/次, 2次/d, 以后视临床情况每两周增加剂量至100 mg/次, 2次/d。两组均连续治疗3个月。比较两组的临床疗效, 同时检测两组治疗前后左室舒张末内径(LVEED)、左室收缩末内径(LVESD)、左房内径(LADD)、左心射血分数(LVEF)、舒张压、心率、心胸比及NYHA分级的变化。结果 对照组和治疗组总有效率分别为82.5%、92.5%, 两组比较差异有统计学意义(P<0.05)。治疗后, 两组患者的LVEED、LVESD、LADD均较治疗前显著降低, LVEF显著升高, 同组治疗前后差异有统计学意义(P<0.05);治疗后, 治疗组的心功能指标改善程度优于对照组, 两组比较差异有统计学意义(P<0.05)。治疗后两组患者的舒张压、心率及心胸比较治疗前明显降低, 同组治疗前后差异有统计学意义(P<0.05);治疗后, 治疗组这些指标改善程度优于对照组, 两组比较差异有统计学意义(P<0.05)。治疗后, 治疗组患者的NYHA分级较治疗前明显降低, 且治疗组低于对照组, 差异有统计学意义(P<0.05)。结论 美托洛尔联合常规疗法治疗风湿性心脏病慢性心力衰竭具有较好的临床疗效, 可有效改善患者的心功能, 降低NYHA分级, 具有一定的临床应用价值。

Objective To investigate the clinical effect of metoprolol in treatment of rheumatic heart disease with chronic heart failure. Methods The patients with rheumatic heart disease with chronic heart failure (80 cases) of People's Hospital of Binhai County from April 2013 to April 2014 were randomly divided into treatment and control groups, and each group had 40 cases. The patients in the control group were given conventional symptomatic treatment. At the same time, they were po administered with Enalapril Maleate Tablets and Spironolactone Tablets. The patients in the treatment group were po administered with Metoprolol Tartrate Tablets, and the first dosage of 6.25 mg/time, twice daily. The dosage was increased every two weeks according to the clinical situation till 100 mg/time, twice daily. Each group was treated for three months. After treatment, the efficacy was evaluated, while the changes of LVEED, LVESD, LADD, LVEF, diastolic blood pressure, heart rate, cardio-thoracic ratio (CTR) and NYHA classification were detected. Results The efficacies in the control and treatment groups were 82.5% and 92.5%, respectively, and there were differences between the two groups (P < 0.05). After treatment, LVEED, LVESD, and LADD in two groups were significantly reduced, LVEF increased significantly, and the difference was statistically significant in the same group before and after treatment (P < 0.05). After treatment, cardiac function indexes in the treatment group improved better than those in the control group, and there were differences between two groups (P < 0.05). After treatment, diastolic blood pressure, heart rate, and CTR were significantly reduced, and the difference was statistically significant in the same group before and after treatment (P < 0.05). After treatment, obvervational indexes in the treatment group improved better than those in the control group, and there were differences between two groups (P < 0.05). After treatment, NYHA classification in the treatment group decreased significantly, and the treatment group was lower than that in the control group, with significant difference between two groups (P < 0.05). Conclusion Metoprolol combined with conventional therapy has the good clinical effect in treatment of rheumatic heart disease with chronic heart failure, and can effectively improve the heart function, can reduce the NYHA classification, which has a certain clinical value.