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目的对68例舒张功能不全性心衰(简称舒张性心衰)患者进行临床分析。方法在积极进行病因治疗的同时,应用利尿剂和硝酸酯类药物缓解症状,常规选用血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)、β受体阻滞剂及钙离子拮抗剂以改善左室舒张功能。入院时及治疗4周后分别行彩色多普勒超声心动图检查,用流速指标测定二尖瓣血流图E/A比值,并观察心功能(NYHA分级)改善情况。结果入院时56例E/A<1者,34例E/A比值增大,22例无改善;12例E/A>1,7例E/A<1,5例无改善。心功能改善2级30例,改善1级34例,4例无改善,死亡1例。结论舒张性心衰主要病因为高血压和冠心病,且随着年龄的增长,发病率呈增加趋势,E/A>1不能排除舒张性心衰的诊断。心房纤颤、心动过速可加重临床症状,应积极纠正,控制心室率在60~70次/m in。小剂量开始应用利尿剂、硝酸酯类药物,β受体阻滞剂开始剂量较大,调整剂量不受时间限制。
Objective To analyze the clinical data of 68 patients with diastolic heart failure (diastolic heart failure). Methods At the same time of positive etiological treatment, diuretics and nitrates were used to relieve the symptoms. Conventional angiotensin converting enzyme inhibitor (ACEI) or angiotensin Ⅱ receptor antagonist (ARB) and β - block Agents and calcium antagonists to improve left ventricular diastolic function. At admission and after 4 weeks of treatment, color Doppler echocardiography was performed. The E / A ratio of mitral flow was measured by flow cytometry and the improvement of cardiac function (NYHA classification) was observed. Results There were 56 cases with E / A <1, 34 cases with E / A ratio increased, 22 cases without improvement; 12 cases with E / A> 1, 7 cases with E / A <1, 5 cases without improvement. Heart function improved 2 grade 30 cases, improved grade 1 34 cases, 4 cases without improvement, 1 case died. Conclusions The main causes of diastolic heart failure are hypertension and coronary heart disease. The incidence of diastolic heart failure increases with age. E / A> 1 can not rule out the diagnosis of diastolic heart failure. Atrial fibrillation, tachycardia can aggravate clinical symptoms, should be actively corrected, control of ventricular rate in 60 to 70 times / m in. Low-dose began to use diuretics, nitrates, β-blockers began a larger dose, adjust the dose from time constraints.