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非选择性β受体阻滞剂治疗充血性心力衰竭对运动耐量的影响
作者：赵辉 寇建会 黄秀英 南海燕 郑岭书 吴欣【关键词】 充血性心力衰竭；运动耐量；卡维地洛；最大摄氧量；无氧阈；运动心肺功能检测
［摘要］ 目的 探讨非选择性β受体阻滞剂治疗充血性心力衰竭对运动耐量的影响。方法 选择近期诊断充血性心力衰竭患者共160例，根据年龄、性别、心功能随机分为两组，每组各80例。其中观察组在常规治疗的基础上加用卡维地洛（carvedilol），对照组仅采用常规治疗。分别于治疗前和治疗6个月后行运动心肺功能检测，检测气体代谢及做功指标。同时记录受试者的症状、体征及心功能分级。结果 观察组心衰复发住院率明显低于对照组（6.67%∶27.59%）。观察组与对照组比较最大摄氧量（VO2max）增大（P＜0.05）；无氧阈（AT）增高（P＜0.05）；通气量（VE）增高（P＜0.05）；通气量（VE）/摄氧量（VO2）增高（P＜0.05）；氧脉搏（O2Pulse）明显增高（P＜0.05）；最大心率增高（P＜0.05）；最大心率增值明显增高（P＜0.05）；运动时间延长（P＜0.05）；最大做功量（Wmax）增高（P＜0.05）；New York心功能分级平均改善0.5级；症状和体征改善（P＜0.05）。结论 充血性心力衰竭患者长期服用非选择性β受体阻滞剂能够通过改善心功能增加运动耐量。
［关键词］ 充血性心力衰竭；运动耐量；卡维地洛；最大摄氧量；无氧阈；运动心肺功能检测
Effects of non-choice β receptor blocked on exercise tolerace when it is used to treat congestive heart failure
［Abstract］ 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.
［Key words］ congestive heart failure;exercise tolerance;carvedilol;maximal oxygen uptake;anaerobic threshold;cardiopulmonary exercise test
交感神经兴奋性增强是心力衰竭（心衰）时机体的重要适应机制之一［１］。持久的交感神经兴奋性过度增强对心脏将产生不利的影响［2，3］。交感神经兴奋性增高引起肾素的过多分泌，这种全身及组织的肾素-血管紧张素-醛固酮（RAS）系统的激活更进一步使交感兴奋性增强，成为恶性循环，这就是常说的慢性充血性心衰（CHF）时神经-内分泌的不良影响。β受体阻滞剂通过抑制交感神经兴奋降低RAS系统活性、使β受体上调、改善心室舒张功能
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