The Clinical Analogy Of Chronic Heart Failure Treated By Carvedilol

Since Sweden scholar Waagstein etc. usedβreceptor inhibitor to treat CHF the first time in 1975, people valued more the important action of theβreceptor inhibitor in CHF, and the best βreceptor inhibitor so far is carvedilol. Carvedilol is the firstβreceptor inhibitor permitted by the FDA to used for treating the CHF, it is a kind of the 3rd generation non-selecting βreceptor inhibitor, having no internal sympathetic activity,it has both αand the βreceptor blockade action, can repress the SNS system and the activity of the RAAS system, weak the heart damage by tension increase of adrenine and the cardiac muscle cell apoptosis, defer the progression of the remodeling of cardiac muscle and the deterioration of heart function, the converse the remodeling of ventricle, improve the contraction function ofcardiac muscle, decline the death rate and hospitalization rate of heart failure sufferers. There are already a series of and large-scale clinical trial confirming the above-mentioned action of carvedilol, but the domestic still lacks this kind of report. This research studied 87 cases of chronic heart failure in 2000-2004 years in the China-Japan Union Hospital, dividing them into two groups randomly, carvedilol group and control group,giving routine treatment ,domestic carvedilol and import carvedilol.we analyse statistics of the changing of heart function and side effects and estimate the curative effect and security of carvedilol,so we can provide some proves for the large scale application of carvedilol in our country. This research studied 87 cases of chronic heart failure in 2000-2004 years in the China-Japan Union Hospital, among them 48 of ischemic heart disease, 31 of dilated cardiomyopathy,8 of hypertensive heart disease. They were divided into two groups randomly: carvedilol group and control group, the control group with 29 people, bench, 18 male,11 female, the average age is 60.5. carvedilol group has 58 people,it is divided into two groups randomly again, among them import carvedilol has 29 people, male 17, female 12 , the average age is 58.2;the domestic group has 29 people, male 16, female 13, the average age is 59.6.The selecting standard is: 1) match the definition and classification of myocardiopathy in the report of 1995 WHO/ ISFC to the demulcent therapye;2)heart function Ⅱ-Ⅲ(NYHA);3) LVEF ≤0.40 confirmed by planar ultrasonic cardiogram;4) received diureses and lanatoside﹥1 week with stable dosage. The method of medicine –administrating is :The hospitalized patients received routine therapy at least 1 week, then accept haematoporphyrin bio-chemical examine and ultrasonic cardiogram , carvedilol group was added import carvedilol(Shanghai Roche company produce) or domestic carvedilol (Peking Huge Ability produce) to use , the former starting dosage is 3.125 mg,2 times/ day, maintaining a week, if the patient can't tolerant this dosage, he or she was then expelled ; If the condition of heart failure didn't aggravate obviously ,the dosage canbe added to 6.25 mg, 2 times per day;afterward if sufferer's tolerance is good, the dosage can be doubled once a week, increase in turn to 12.5 mg, 2 times per day,25 mg, 2 times per day;The latter starting dosage is 2.5 mg.s, 2 times per day, the adding pattern is the same to the former and the target dosage is 20 mg, 2 times per days.The control group received diureses and lanatoside therapy. The total time of observation is six monthes. Before and after the observation, the index monitored included: LVDd, LVEF, LVFS, SV, CO, at the same time the blood pressure, heart rate and NYHA heart function classification was recorded. The index evaluating the safety included patient withdrawing the trial, side-effect occuring rate, life sign and the laboratory examinations etc., the laboratory examinations including hemo and urine regulation, function of kidney and liver, electrolyte and blood glucose. The data recieved statisticsly anylasis, the measuring data was showed as x ±S, adopting the t testing;the counting data adoptedχ2 testing . P<0.05 showed statistical difference. The statistic result manifested: the indexes of three groups before treated did not show statistic difference include ultrasonic cardiogram index, blood pressure, heart rate and weights. The control group's SV increased(P﹤0.05), heart function improved(P﹤0.05), but the other index didn't change.The indexes of carvedilol group all changes: LVDd decreased(P﹤0.01), LVEF increased(P﹤0.01), LVFS, SV, CO allincreased(P﹤0.05).The heart function improved markedly (P﹤0.01), blood pressure and heart rate descented;( P﹤0.05). The import carvedilol and domestic carvedilol did not show statistic difference. The case of toleranting target dosage in carvedilol group is 41, the proportion is 69.0%, among them 7 cases in domestic carvedilol can't tolerant target dosage, the average toleranting dosage is(34.82 ±4.12) mg/ d, 11 cases in import carvedilol can't tolerant target dosage, the average toleranting dosage is(38.36 ±6.97) mg/ d.The Ridit testing confirmed that there was no statistic difference between the two groups. The main reason of no-toleranting was declining of blood pressure (systolic pressure<85 mmHgs) and descenting heart rate to reduce slow( heart rate<55 times/ min). 29 cases (times) side-effect occurred in carvedilol group, were mainly dizziness (14 times), tireness(9 times) and nausea(6 times), the symptom was light and tolerent. The control group had no alike side-effect. The import and domestic carvedilol group did not show the statistic difference. The hemo and urine regulation, function of kidney and liver, electrolyte and blood glucose before and after observation. There were 2 death in both carvedilol group and control group,1 death in both import and domestic carvedilol group . The reason of death was sudden cardiac death (3 cases), cerebral hemorrhage (1 cases), because the cases was too little and the observation time was limited, we did not make the statistics analyse.