医药学论文：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

　　［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%）.cnpared 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、减低心肌耗氧量改善心功能，增加运动耐量。理论上讲β受体阻滞剂可以通过改善心功能增加充血性心力衰竭患者的运动耐量，也可通过抑制心率降低患者的运动耐量，它对运动耐量产生的净效应目前国内外尚无相关报道。本课题采用随机对照的试验方法，观察非选择性β受体阻滞剂在治疗充血性心力衰竭对运动耐量的影响。