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目的:探讨靶剂量美托洛尔治疗合并糖尿病的慢性心衰患者的临床疗效及安全性。方法:选取154例老年糖尿病并慢性心衰患者,随机分为观察组与对照组,每组77例,观察组患者予靶剂量美托洛尔及常规治疗方案,对照组仅按常规治疗方案进行治疗,比较两组患者治疗前后NYHA分级、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、6min步行距离及用药安全性。结果:与治疗前相比,观察组与对照组两组患者NYHA分级、LVESD、LVEDD、LVEF、6min步行距离均有明显改善(P<0.05);与对照组患者治疗后相比,观察组患者治疗后以上指标改善更加显著(P<0.05)。在随访的6个月内,观察组心脏事件发生率为3.90%,明显低于对照组的14.29%(P<0.05)。两组患者平均空腹血糖、糖化血红蛋白不存在显著性差异(P>0.05),观察组血脂、血糖、肝功能、肾功能等指标均未发生显著变化。结论:靶剂量美托洛尔治疗合并糖尿病的慢性心衰患者时,可显著改善患者的心功能及活动耐量,临床疗效好,安全性高,耐受性良好。
Objective: To investigate the clinical efficacy and safety of target dose metoprolol in patients with chronic heart failure complicated with diabetes. Methods: A total of 154 elderly patients with diabetes mellitus and chronic heart failure were randomly divided into observation group and control group, with 77 patients in each group. Patients in the observation group received the metoprolol at the target dose and the conventional treatment regimen. The control group was treated according to the conventional regimen NYHA classification, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), walking distance and medication safety were compared between the two groups before and after treatment. Results: Compared with those before treatment, NYHA classification, LVESD, LVEDD, LVEF and 6min walking distance in observation group and control group were significantly improved (P <0.05). Compared with control group, the patients in observation group After treatment, the above indicators improved more significantly (P <0.05). Within 6 months of follow-up, the incidence of cardiac events in the observation group was 3.90%, which was significantly lower than that in the control group (14.29%, P <0.05). The average fasting blood glucose and glycosylated hemoglobin in the two groups had no significant difference (P> 0.05). There was no significant change in the indexes of blood lipid, blood glucose, liver function and renal function in the two groups. Conclusion: Metoprolol at target dose can significantly improve cardiac function and activity tolerance of patients with chronic heart failure complicated with diabetes, and has good clinical efficacy, high safety and good tolerability.