非選擇性β受體阻滯劑治療充血性心力衰竭對運動耐量的影響

非選擇性β受體阻滯劑治療充血性心力衰竭對運動耐量的影響

作者：趙輝　寇建會　黃秀英　南海燕　鄭嶺書　吳欣
【關鍵詞】 充血性心力衰竭；運動耐量；卡維地洛；最大攝氧量；無氧閾；運動心肺功能檢測
［摘要］ 目的 探討非選擇性β受體阻滯劑治療充血性心力衰竭對運動耐量的影響。方法 選擇近期診斷充血性心力衰竭患者共160例，根據年齡、性別、心功能隨機分為兩組，每組各80例。其中觀察組在常規治療的基礎上加用卡維地洛（carvedilol），對照組僅采用常規治療。分別于治療前和治療6個月后行運動心肺功能檢測，檢測氣體代謝及做功指標。同時記錄受試者的癥狀、體征及心功能分級。結果 觀察組心衰復發住院率明顯低于對照組（6.67%∶27.59%）。觀察組與對照組比較最大攝氧量（VO2max）增大（P＜0.05）；無氧閾（AT）增高（P＜0.05）；通氣量（VE）增高（P＜0.05）；通氣量（VE）/攝氧量（VO2）增高（P＜0.05）；氧脈搏（O2Pulse）明顯增高（P＜0.05）；最大心率增高（P＜0.05）；最大心率增值明顯增高（P＜0.05）；運動時間延長（P＜0.05）；最大做功量（Wmax）增高（P＜0.05）；New York心功能分級平均改善0.5級；癥狀和體征改善（P＜0.05）。結論 充血性心力衰竭患者長期服用非選擇性β受體阻滯劑能夠通過改善心功能增加運動耐量。

　　［關鍵詞］ 充血性心力衰竭；運動耐量；卡維地洛；最大攝氧量；無氧閾；運動心肺功能檢測

　　Effects of non-choice β receptor blocked on exercise tolerace when it is used to treat congestive heart failure
　�。跘bstract］ Objective This article discusses the effect of non-choice β receptor blocked on exercise tolerace when it is used to treat congestive heart failure（CHF）.Methods 160 patients were enrolled who with CHF and NYHA heart function class Ⅰ to Ⅲ degree grade.The patients were divided into two groups at random according to their age,sex,and pump function.There were 80 patients in each group.Observing groups had a Carvedilol on the basis of the routine treatment;control group only received the routine treatment.The patients of the two groups should have been examined with cardiopulmonary exercise test respectively six months before and after the treatment.Afterwards,we evaluated gas metabolism or work index.At the same time,we recorded the examinees' symptom,physical sign and pump function grade.Results During the experiment two patients died,difference from observing group and control group each.Observing groups were apparently lower than control group in heart failure recurrence admission rate（6.67%∶27.59%）.Compared with control group,maximal oxygen uptake had obviously rised （P＜0.05）in observing groups;anaerobic threshold had increased （P＜0.05）;ventilate capacity increased （P＜0.05）;ventilate capacity/oxygen uptake increased （P＜0.05）;oxygen pulse had improved （P＜0.05）;maximal heart rate rised （P＜0.05）;maximal heart rate increment increased （P＜0.05）;exercise time extensed （P＜0.05）;maximal work had improved （P＜0.05）;maximal work increased （P＜0.05）;and NYHA heart function grade had enhanced 0.5 grade on average.Symptom and physical sign had improved （P＜0.05）.Conclusion CHF patients could improve heart function and increase exercise tolerace by having a non-choice β receptor blocked long time.
　�。跭ey words］ congestive heart failure;exercise tolerance;carvedilol;maximal oxygen uptake;anaerobic threshold;cardiopulmonary exercise test

　　交感神經興奮性增強是心力衰竭（心衰）時機體的重要適應機制之一［１］。持久的交感神經興奮性過度增強對心臟將產生不利的影響［2，3］。交感神經興奮性增高引起腎素的過多分泌，這種全身及組織的腎素-血管緊張素-醛固酮（RAS）系統的激活更進一步使交感興奮性增強，成為惡性循環，這就是常說的慢性充血性心衰（CHF）時神經-內分泌的不良影響。β受體阻滯劑通過抑制交感神經興奮降低RAS系統活性、使β受體上調、改善心室舒張功能

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