America Tuoluoerjia Shengmai capsule in chronic renal failure and the efficacy of chronic heart failure
【Abstract】 Objective To evaluate the US Tuoluoerjia
Shengmai capsule in treating chronic renal failure (CRF) and chronic heart failure (CHF) the clinical efficacy and safety. Methods 52 patients with chronic renal failure associated with chronic heart failure patients were randomly divided into treatment group (27 cases) and control group (25 cases). Follow-up 6 months before and after treatment were measured heart rate, blood pressure, using echocardiography to measure efficacy of cardiac function. Results 48 patients completed the study, two groups after treatment of left ventricular end-
diastolic diameter, left ventricular end-systolic diameter
(LVEDD), (LVESD), cardiac function, symptoms were improved, but the treatment group than control group, two groups have more significant difference (P <0.05), the two groups after treatment compared with the treatment group blood pressure and
heart rate decreased significantly (P <0.01), the two groups after treatment of blood pressure in patients with no significant difference (P> 0.05) and heart rate, there was a significant difference (P "0.01). Conclusion on the basis of conventional therapy US Tuoluoerjia Shengmai capsules can improve chronic renal failure and in patients with chronic heart failure symptoms and heart function, the vast majority of patients can tolerate the treatment.
Key words Shengmai capsules metoprolol in chronic heart
failure with chronic renal failure
Clinical Dbservation of the Curative Effect of Metoprolol and Shengmai Capsule in Treating Chronic Renal Failure and Chronic Heart Failure
Abstract: ObjectiveTo evaluate the efficacy and safety
profile of metoprolol and Shengmaimai capsule in chronic renal failure (CRF) and chronic heart failure (CHF). Methods52 cases patients with CRF and CHF were divided into treatment group (27 cases) and control group (25 cases). All the patients were followed up for months and measured respectively the changes of heart rate (HR), blood puessure (BP) and cardiac function by the colur Dopper ECE.Results48 patients completed the treatment.The LVEDD, LVESD, heart function and symptoms were improved in both groups while the treatment group was more obvious than the control group (P <0.05). The result of HR and BP decreased significantly after treatemt comparatively (P <0.05), while the HR in the treatment decreased more obvious than the control group (P <0.01), but there was no significant
difference in HR (P> 0.05). ConclusionOn the basis of routine therapy metoyrolol and Shengmaimai capsule can improve the symptoms and heart function significantly in patients with CRF and CHF. Most of patients are able to endure therapy.
Key words: Metoprolol; Shengmai capsule; CRF; CHF
As people of diabetes, hypertension and other means to improve the treatment of chronic renal failure (CRF) the incidence increased year by year, while the cardiovascular complications are leading causes of death CRF, chronic heart failure, cardiovascular complications also accounted for the top. After 30 years of clinical research, a large number of clinical trials have confirmed that β-blockers can reduce
mortality in patients with chronic heart failure, its treatment in patients with chronic heart failure has been
fully affirmed the position and has become the United States, Europe, and our country with chronic heart failure treatment guidelines and other key drugs recommended by one of [1 ~ 3]. However, β-blocker treatment of chronic renal failure
complicated with chronic heart failure adverse effects of treatment of larger, less clinical application. In this study,
the US Tuoluoerjia Shengmai capsules of 52 patients with chronic renal failure in patients with chronic heart failure treatment, and achieved good effect, are reported below.
1 Data and methods
1.1 Clinical data
Purpose of this study 2005-01 ~ 2006-06 our hospital and
outpatient admissions for chronic renal failure in patients with chronic heart failure, 52 cases were not before the
dialysis treatment, serum creatinine of 325 ~ 1 080 μmol / L,
cardiac function NYHA pm Grade 10 cases of grade ?, ? grade
29 cases, ? grade 13 cases, 31 cases were male and 21 female patients were randomly divided into treatment group and
control group. Control group was given calcium antagonists, diuretics, digitalis and other conventional treatment. The treatment group on the basis of conventional therapy plus metoprolol and health with pulse capsules. Inclusion criteria: ? NYHA cardiac function classification ? ~ ? grade patients
after conventional treatment, heart failure under initial control, condition stable, able to lie horizontally at least 30 min or more; ? left ventricular ejection fraction (LVEF) ? 45%; ? sinus rhythm; ? nearly 3 months have not been
taking metoprolol and other β-blockers. Exclusion criteria:
? Echocardiography shows moderate mitral valve regurgitation; ? have adopted the β-receptor blocker contraindications,
such as sinus bradycardia, ? degrees or higher
atrioventricular block, asthma, etc. patients; ? there are
other systems of serious illness .
Treatment group Shengmai capsules 3 times / d, 3 tablets / times; metoprolol tablets (metoprolol tartrate), the initial dose was 6.25 mg, 2 times / d orally, if tolerated the previous dose, then every every other two weeks increasing the dose of 12.5 mg / d, such as the former a low dose of hypotension, bradycardia, heart failure, and increased fluid
retention and so on, can be deferred amount, those who can not tolerate, adjust diuretics and calcium ions antagonists such as dosage, if necessary, hemodialysis 3 ~ 5 times, until the adverse reactions disappeared, according to the above method to observe the patient tolerated the situation, and gradually
increased to 25 mg, 2 times / d, persist in taking follow-up
of 8 months, by the amount of pre-test heart rate, blood
pressure and electrocardiogram, liver and kidney function regularly reviewed. The control group received only chronic
renal failure and chronic heart failure of conventional therapy.
1.3 OUTCOME MEASURES echocardiography before and after treatment using color instrument checks, left ventricular end-
diastolic diameter (LVEDD), left ventricular end-systolic
diameter (LVESD), with an area of long-axis method to
calculate left ventricular ejection fraction (LVEF), measured in all patients 2 times, whichever is the average, cardiac function using NYHA classification, heart failure symptoms using the symptom score (0 ~ 13 minutes) .
1.4 statistical measurement data with ? s, said, using t
test, count data using χ2 test, P <0.05 for the difference
b Follow-up (5.01 ? 1.32) months, 49 cases of patients
completed the follow-up (treatment group, 24 patients in the
control group 25 cases, 3 cases were lost), 8 cases of maximum dose of 25 mg, 2 times / d, mean (15.6 ? 12.1 ) mg / d.
2.1 General clinical data of two groups before treatment in patients with age, renal function, cardiac function in both
matches, in Table 1. Table 1 the two groups before the general condition of patients with drug comparison (omitted)
2.2 before and after treatment groups LVEDD, LVESD, LVEF, and clinical efficacy comparison in Table 2 ~ 3. Table 2 groups after treatment in patients with echocardiographic comparison (omitted) the two groups in Table 3 Comparison of
clinical efficacy in patients after treatment (omitted) reposted elsewhere in the paper for free download http://
Before treatment groups LVEDD, LVESD, and LVEF did not
differ significantly after the treatment the treatment group compared with the control group heart rate decreased significantly (P <0.01), symptoms and improved cardiac function compared with the previous classification (P <0.05),
the two groups after treatment compared with patients pre-
treatment systolic and diastolic blood pressure decreased significantly (P <0.01), after treatment had no significant difference (P> 0.05), observed the end of the treatment group, LVEDD, LVESD compared with the control group reduced (P
<0.05), LVEF increased (P <0.05), course of treatment, the treatment group ? degree atrioventricular block occurred in 3 cases, ?-degree atrioventricular block two cases, reduction after the disappearance of three cases of congestive heart
failure aggravated by hemodialysis remission not withdraw from observation.
With the study of the pathogenesis of chronic heart failure continued to deepen, it is growing recognition that over-stimulate the nerves involved in the secretion of chronic heart failure development, and increase β-blocker with β-
receptor signal transduction pathway, to improve the left ventricular ejection fraction (LVEF), exercise tolerance enhancement effect [6,7]. It can also, through its biological
effects to improve the contractile function of myocardial cells, leaving ventricular systolic function improved significantly. Therefore, β-blocker treatment of chronic
heart failure heart medicine has been widely used, but in chronic renal failure in patients with heart failure, chronic renal failure due to excretion of obstacles, myocardial damage caused by uremic toxins, easy to appear electrolyte imbalance, anemia and the application of such factors as lack of experience, β-blocker use are subject to certain
Shengmai capsule is derived from the Cuban side of the modern traditional Chinese medicine preparation Shengmaisan from ginseng, Ophiopogon, Schisandra composition, modern medical research that has a strong heart Shengmaisan class
preparations and increase coronary blood flow, anti-oxidation,
there is Enhanced myocardial hypoxia tolerance, on myocardial ischemia-reperfusion injury have protective effect, so that ischemia and hypoxia of the myocardial cells accelerated
restoration and protection, resulting in the release of cAMP and cGMP reduced, thereby improving the energy metabolism during hypoxia . Clinical study found that Shengmai Capsule also has to improve renal function, reduce glomerular permeability, reduce urinary protein excretion and improve renal function of microcirculation .
This study showed that metoprolol can significantly improve the chronic renal failure complicated with chronic heart failure in patients with blood pressure, heart rate,
long-term use can effectively improve the patient's cardiac function, increased left ventricular ejection fraction, to alleviate the symptoms of heart failure. However, in clinical applications should be noted that heart function should first be stable medication; followed by chronic renal failure in patients with β-blocker dosage in patients with chronic heart failure compared with ordinary use less, which may be excreted in patients with chronic renal failure barriers to extend the half-life of drug in the body; and third, have a more severe anemia, and hyperkalemia in patients with heart failure appears easy to add, this study three cases of this are two kinds of patients with heart failure increased, but were obtained after hemodialysis ease. So for chronic renal failure
in patients with chronic heart failure before treatment to correct anemia and hyperkalemia attention and strict observation of adverse drug reactions, the symptoms increase the time line of blood dialysis.
 Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic lieart failure. Task force for the diagnosis and treatment of chronic heart failure, European Society of Cardiology [J]. EurHeart J, 2001,22 (17): 1527.
 Cardiovascular Branch of Chinese Medical Association. Recommendations for treatment of chronic systolic heart failure [J]. Zhonghua Cardiology, 2002,30 (1): 7.
 Maria Ansari, Michael G.shlipak, Paul A. et
al.Improving Guideline Adherence: A Randomized Trail Evaluating Srtrategies to Inereuseβ-Blocker Use in Heart
Failure [J]. Circulation, 2003,107 (22): 2799.
 Guazzi M, Agostone P, Matturri M, et al.Pulmonary function, cardiac function, and exercise capacity in a follow
- up of patients with congestive heart failure treated with carvedilol [J]. American Heart Joutnal, 1999,138: 460.
 Ming-Jer Chen. Cardiology (on the) [M]. Beijing: Beijing Medical University Press, 1999,482.
 Squire IB, Banett DB, The rational use of β-
adrenoceptor blockets in the treatment of heart failure. The
changing face of an old therapy [J]. Br J clin Pharmacol, 2000.49:1.
 Rockmam HA, chien KR, choi DJ et al. Expression of a
β-adrenergic receptor kinase Iinbibitor prevents the development of myocardial failure in gene targeted mice [J]. Proc Natl Acad Sci USA, 1998,95:7000.
 Zuo-Yu Tan, Zhu Yuping, Yang Xue. Shengmai injection treatment of diabetic nephropathy [J]. Modern rehabilitation, 2000,4 (12): 88. Reposted elsewhere in the paper for free Download Center http://