标题：美托洛尔对老年CHF合并COPD患者疾病进程和心肺功能的影响

      作者：何莹 1，程媛媛 2，刘玉杰 3    1.铜川矿务局中心医院老年病科，陕西 铜川 727000；2.西安医学院第三附属医院心内科，陕西 西安 710001；3.铜川矿务局中心医院心内科，陕西 铜川 727000

      卷次： 2021年32卷23期

      【摘要】 目的 观察美托洛尔对老年慢性心力衰竭(CHF)合并慢性阻塞性肺疾病(COPD)患者疾病进程和心肺功能的影响。方法 选取铜川矿务局中心医院于2017年7月至2020年7月收治的老年CHF合并COPD患者80例，采用简单随机方法将其分为观察组40例和对照组40例。对照组患者给予血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)、螺内酯、利尿剂等药物治疗，观察组患者在对照组治疗的基础上给予美托洛尔治疗。比较两组患者治疗前和治疗6个月后的心肺功能指标、心率、血压的差异，检测并比较两组患者治疗前和治疗6个月后的血清心肌酶水平，并采用美国乔治医院呼吸问卷(SGRQ)评价两组患者治疗前和治疗6个月后的生活质量。结果 治疗后观察组患者的6 min步行距离(6MWT)为(305.56±51.74) m，明显长于对照组的(279.36±60.11) m，差异有统计学意义(P<0.05)，但两组患者治疗前后的左室射血分数(LVEF)、第 1秒用力呼气容积与预测值的比值(FEV1预测值%)、用力肺活量(FVC)、FEV1/FVC比较，以及观察组患者治疗后的心肺功能指标分别与对照组比较差异均无统计学意义(P>0.05)；治疗后两组患者的收缩压(SBP)、舒张压(DBP)、心率明显低于治疗前，且观察组患者治疗后的血压、心率明显低于对照组，差异均有统计学意义(P<0.05)；对照组患者治疗后的肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH)明显低于治疗前，差异均有统计学意义(P<0.05)，而肌酸激酶(CK)与治疗前比较差异无统计学意义(P>0.05)；观察组患者治疗后的CK、CK-MB和LDH明显低于治疗前，差异均有统计学意义(P<0.05)，但观察组患者治疗后的血清心肌酶分别与对照组比较差异均无统计学意义(P>0.05)；治疗后两组患者的SGRQ评分明显低于治疗前，且观察组治疗后的SGRQ评分明显低于对照组，差异均有统计学意义(P<0.05)。结论 美托洛尔用于老年CHF合并COPD的治疗可有效控制患者的血压、心率，达到抗心衰、改善生活质量的效果，延缓疾病进程。
      【关键词】 美托洛尔；老年；慢性心力衰竭；慢性阻塞性肺疾病；心肺功能
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2021）23—3015—04

Effect of metoprolol on disease process and cardiopulmonary function in elderly patients with chronicheart failure complicated with chronic obstructive pulmonary disease.
HE Ying 1, CHENG Yuan-yuan 2, LIUYu-jie 3. 1. Department of Geriatrics, Tongchuan Mining Bureau Central Hospital, Tongchuan 727000, Shaanxi, CHINA;2. Internal Medicine-Cardiovascular Department, the Third Affiliated Hospital of Xi’an Medical College, Xi'an 710001,Shaanxi, CHINA; 3. Internal Medicine-Cardiovascular Department, Tongchuan Mining Bureau Central Hospital,Tongchuan 727000, Shaanxi, CHINA
【Abstract】 Objective To observe the effect of metoprolol on the disease progression and cardiopulmonaryfunction in elderly patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD).Methods A total of 80 elderly patients with CHF and COPD who were admitted to Tongchuan Mining Bureau CentralHospital from July 2017 to July 2020 were selected and divided into an observation group (40 cases) and a control group(40 cases) by a simple random method. Patients in the control group were treated with angiotensin-converting enzyme in-hibitor (ACEI)/angiotensin Ⅱ receptor antagonist (ARB), spironolactone, diuretics and other drugs, and patients in theobservation group were treated with metoprolol on the basis of the treatment in the control group. The differences in car-diopulmonary function indexes, heart rate, and blood pressure between the two groups before treatment and after 6months of treatment was recorded and compared, and the levels of serum myocardial enzymes before and after 6 monthsof treatment were detected and compared. St George's Respiratory Questionnaire (SGRQ) was used to evaluate the quali-ty of life of the two groups of patients before treatment and 6 months after treatment. Results After treatment, the6-minute walking distance (6MWT) of the observation group was (305.56 ± 51.74) m, which was significantly longerthan (279.36±60.11) m of the control group (P<0.05). There was no statistically significant difference between the twogroups in left ventricular ejection fraction (LVEF), the ratio of forced expiratory volume in the first second to the predict-ed value (FEV1 predicted value%), forced vital capacity (FVC), FEV1/FVC, and the cardiopulmonary function indexes