美托洛尔联合硝酸甘油治疗老年高血压伴左心衰的临床分析

目的：观察美托洛尔联合硝酸甘油治疗老年高血压伴左心衰的临床疗效及其对血管内皮生长因子（VEGF）,高敏C反应蛋白（hs-CRP）和脑钠素（BNP）的影响。方法：选取2009年6月至2010年12月入住我院的高血压伴急性左心衰患者150例,将其随机分为观察组和对照组,每组各75例。对照组在强心,利尿的基础上予以硝酸甘油治疗;观察组在对照组的基础上予以美托洛尔治疗。观察两组的疗效,血压,心率,血氧饱和度,血浆VEGF,hs-CRP和BNP的表达。结果：观察组的总有效率为94.67%,而对照组的总有效率为80.00%,观察组的总有效率明显高于对照组（P〈0.05）。两组治疗后,收缩压,舒张压,心率,VEGF,hs-CRP和BNP均较治疗前明显降低（P〈0.01）,观察组的降低水平较对照组更为明显（P〈0.01）;而两组治疗后的血氧饱和度较治疗前明显提高,观察组的提高水平更为明显（P〈0.01）。结论：美托洛尔联合硝酸甘油治疗老年高血压伴左心衰疗效显著,其机理可能与降低血浆中的VEGF,hs-CRP和BNP水平有关。

Clinical Analysis of Hypertension with Left Heart Failure in Elderly Patient Treated with Metoprolol and Nitroglycerin

Objective： To observe the efficacy of hypertension with left heart failure in elderly patient treated with metoprolol and nitroglycerin and its effect on vascular endothelial growth factor （VEGF）, high-sensitivity C-reactive protein （hs-CRP） and brain natriuretic peptide（BNP）. Methods： 150 patients of hypertension with left heart failure from June 2009 to December 2010, were randomly divided into observation group and control group, each group had 75 cases. Control group was given nitroglycerin on the basic treatment such as cardiac and diuretic treatment and so on; observation group was given metoprolol on the basis of the control group. The efficacy, blood pressure, heart rate, oxygen saturation, VEGF, hs-CRP and BNP were observed in each group. Results： The total effective rate of the observation group was 94.67%, while 80.00% in control group, the total effective rate in observation group was significantly higher compared with control group （P 〈0.05）. After treatment, the levels of systolic blood pressure, diastolic blood pressure, heart rate, VEGF, hs-CRP and BNP significantly reduced than those before treatment （P〈0.01）, the levels of the observation group is more obvious than that of the control group （P〈0.01）. While, the levels of oxygen saturation improved in each group after treatment as compared with before treatment, the levels of the observation group rised more than that of the control group （P〈0.01）. Conclusion： The hypertension with left heart failure treated with metoprolol combined with nitroglycerin in elderly patients is effective, its mechanism may be associated with decreased plasma levels ofVEGF, hs-CRP and BNP.