探讨厄贝沙坦氢氯噻嗪辅助治疗老年重症心力衰竭的效果及对血流动力学的影响[摘要]目的研究厄貝沙坦联合氢氯噻嗪辅助美托洛尔治疗老年重症心力衰竭的效果及其对血流动力学的影响。方法选取2015年12月～2017年1月在我院治疗并确诊重症心力衰竭的97例老年患者作为研究对象，根据随机对照法将其分为研究组（n=47）和对照组（n=50）。对照组患者给予口服酒石酸美托洛尔片治疗，研究组患者在此基础上再给予厄贝沙坦、氢氯噻嗪片治疗，共治疗2个月。比较两组患者的治疗效果、治疗前后心脏结构及血流动力学指标变化、不良反应发生情况。结果研究组患者的治疗总有效率明显高于对照组，差异有统计学意义（P<0.05）。治疗后，研究组患者的左心室射血分数（LVEF）明显高于对照组，两组患者的LVEF均明显高于治疗前，差异有统计学意义（P<0.05）。治疗后，两组患者的体循环血管阻力（SVR）、肺动脉楔压（PAWP）、肺动脉平均压（PAMP）、右心房压（RAP）均低于治疗前，心排血量（CO）、心脏指数（CI）较高于治疗前，差异有统计学意义（P<0.05）。治疗后，研究组患者的PAWP、PAMP、SVR明显低于对照组，CO高于对照组，差异有统计学意义（P<0.05），而两组患者的RAP、CI比较，差异无统计学意义（P>0.05）。两组患者治疗期间的药物不良反应总发生率比较，差异无统计学意义（P>0.05）。结论厄贝沙坦联合氢氯噻嗪辅助治疗老年重症心力衰竭患者的效果优于单纯使用美托洛尔，且对患者的血流动力学改善作用较为明显。[关键词]厄贝沙坦；氢氯噻嗪；心力衰竭；血流动力学；辅助治疗[abstract]ObjectiveTostudytheeffectofirbesartancombinedwithhydrochlorothiazideinthetreatmentofelderlypatientswithsevereheartfailureanditsinfluenceonhemodynamics.Methods97elderlypatientswithsevereheartfailurewhoweretreatedanddiagnosedinourhospitalfromDecember2015toJanuary2017wereselectedasstudysubjects.Theywerepidedintostudygroup(n=47)andcontrolgroup(n=50)accordingtorandomizedcontrolmethod.Patientsinthecontrolgroupweretreatedwithmetoprololtartratetabletsorally,whilepatientsinthestudygroupweretreatedwithirbesartanandhydrochlorothiazidetabletsfor2months.Thetherapeuticeffect,changesofcardiacstructureandhemodynamicparametersbeforeandaftertreatment,andoccurrenceofadversereactionswerecomparedbetweenthetwogroups.ResultsThetotaleffectiverateofthestudygroupwassignificantlyhigherthanthatofthecontrolgroup(P<0.05).Aftertreatment,theleftventricularejectionfraction(LVEF)ofthestudygroupwassignificantlyhigherthanthatofthecontrolgroup,andtheLVEFofthetwogroupswassignificantlyhigherthanthatbeforetreatment(P<0.05).Aftertreatment,thesystemicvascularresistance(SVR),pulmonarywedgepressure(PAWP),meanpulmonaryarterypressure(PAMP),rightatrialpressure(RAP)ofthetwogroupswerelowerthanthosebeforetreatment,andthecardiacoutput(CO)andcardiacindex(CI)werehigherthanthosebeforetreatment,thedifferencewasstatisticallysignificant(P<0.05).Aftertreatment,PAWP,PAMPandSVRinthestudygroupweresignificantlylowerthanthoseinthecontrolgroup,andCOwassignificantlyhigherthanthoseinthecontrolgroup(P<0.05),whiletherewasnosignificantdifferenceinRAPandCIbetweenthetwogroups(P>0.05).Therewasnosignificantdifferenceinthetotalincidenceofadversedrugreactionsbetweenthetwogroups(P>0.05).ConclusionIrbesartancombinedwithhydrochlorothiazideissuperiortometoprololaloneintheadjuvanttreatmentofelderlypatientswithsevereheartfailure,anditshemodynamicimprovementisobvious.[Keywords]irbesartan;hydrochlorothiazide;heartfailure;hemodynamics;adjuvanttherapy.伴随着人口老龄化的逐渐加重，慢性心血管疾病的发生率逐年上升，慢性心力衰竭（chronicheartfailure，CHF）就是其中比较严重的一种。在我国2003年的大规模抽样调查中[1]，CH...