目的 探討托拉塞米聯(lián)合美托洛爾治療慢性充血性心力衰竭的臨床療效。方法 選取2017年1月－2018年12月在延安大學(xué)附屬醫(yī)院接受住院治療的116例慢性充血性心力衰竭患者為研究對(duì)象。對(duì)照組患者口服酒石酸美托洛爾片，起初6.25 mg/次，2~3次/d，以后視臨床情況每數(shù)日至1周增加6.25~12.5 mg，2~3次/d，最大劑量可用至50~100 mg/次，2次/d；觀察組在對(duì)照組基礎(chǔ)上加用托拉塞米片，起初劑量為10 mg/次，1次/d，以后視臨床情況可將劑量增至20 mg/次，1次/d，最大劑量可用至每日40 mg。兩組患者均連續(xù)治療7 d。觀察兩組患者的臨床療效，同時(shí)比較兩組患者治療前后的二尖瓣舒張?jiān)缙谂c舒張晚期血流峰值速度比值（E/A）、左室射血分?jǐn)?shù)（LVEF）、左心室舒張末期內(nèi)徑（LVEDD）、左室收縮末期內(nèi)徑（LVESD）、血鈉、血鉀、血肌酐（Scr）、血清嗜鉻粒蛋白A（CgA）及半乳糖凝集素-3（galectin-3）水平。結(jié)果 治療后，觀察組患者總有效率為87.9%，明顯高于對(duì)照組的70.7%（P<0.05）。治療后，兩組患者LVEDD、LVESD均顯著降低（P<0.05），與對(duì)照組比較，觀察組下降程度更明顯（P<0.05）；兩組患者E/A、LVEF均顯著上升（P<0.05），與對(duì)照組比較，觀察組上升程度更明顯（P<0.05）。治療后，兩組24 h尿量顯著增多（P<0.05），并且觀察組24 h尿量顯著多于對(duì)照組（P<0.05）；治療后，兩組患者血鈉、血鉀、Scr的比較差異均無(wú)統(tǒng)計(jì)學(xué)意義。治療后，兩組患者血清CgA及galectin-3水平顯著降低（P<0.05），且觀察組明顯低于對(duì)照組（P<0.05）。結(jié)論 托拉塞米聯(lián)合美托洛爾治療慢性充血性心力衰竭療效較好，有利于緩解臨床癥狀，改善心功能，降低血清CgA和galectin-3的水平，抑制心肌纖維化進(jìn)程，明顯改善心室重構(gòu)，提高治療效果。

Objective To analyze the clinical effcacy of torasemide combined with metoprolol in treatment of chronic congestive heart failure. Methods A total of 116 chronic congestive heart failure patients hospitalized in the Yan'an University Affiliated Hospital from January 2017 to December 2018 were selected as study subjects. Patients in the control group were po administered with Metoprolol Tartrate Tablets, 6.25 mg/time, 2-3 times daily, and then increased 6.25-12.5 mg, 2-3 times daily, depending on the clinical situation every days to a week. The maximum dose could be up to 50-100 mg/time, twice daily. Patients in the observation group were po administered with Torasemide Tablets on the basis of the control group, the initial dose was 10 mg/time, once daily, and the dose could be increased to 20 mg/time, once daily depending on the clinical situation. The maximum dose could be up to 40 mg per day. Both groups received continuous treatment for 7 days. After treatment, the clinical efficacy of two groups were compared, and the levels of E/A, LVEF, LVEDD, LVESD, serum sodium, potassium, Scr, CgA, and galectin-3 before and after treatment were compared. Results After treatment, the total effective rate in the observation group was 87.9%, which was significantly higher than 70.7% in the control group (P<0.05). After treatment, LVEDD and LVESD in both groups were significantly reduced (P<0.05). Compared with the control group, the degree of reduction in the observation group was more significant (P<0.05). E/A and LVEF were significantly increased in both groups (P<0.05), and the increase was more significant in the observation group than in the control group (P<0.05). After treatment, urine output in two groups increased significantly at 24 h (P<0.05), and the observation group was significantly higher than the control group (P<0.05). After treatment, there were no statistically significant differences in serum sodium, serum potassium and Scr between two groups. After treatment, serum CgA and galectin-3 levels in two groups were significantly decreased (P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusion Torasemide combined with metoprolol has a good therapeutic effect on chronic congestive heart failure, which is beneficial to the alleviation of clinical symptoms, improvement of cardiac function, reduction of serum CgA and galectin-3 levels, inhibition of myocardial fibrosis process, significant improvement of ventricular remodeling, and improvement of therapeutic effect.

R972

延安市科技攻關(guān)計(jì)劃項(xiàng)目（2017KS-03）