King J, Steingo L, Barlow J B, Jardine R, Goldman A P, Allman B, Pocock W A
S Afr Med J. 1983 Sep 28;64(14):510-5.
Fifty patients in severe congestive heart failure (CHF) were treated with captopril (Capoten; Squibb), an oral angiotensin-converting enzyme inhibitor, over a 2-year period (range 3-24 months, mean 8,6 +/- 7,7 months). At entry, all patients were in New York Heart Association (NYHA) functional class IV despite high-dose diuretic and conventional vasodilator therapy. The overall cumulative survival at 6 and 12 months was 64% and 53% respectively. There were 22 deaths (18 during captopril therapy) including 8 sudden deaths. At 2-year follow-up (mean 14,6 +/- 6,9 months), there were 25 survivors on captopril; 18 in NYHA class I or IIS and 7 in class IIM or III. Diuretic requirements were decreased considerably in all. Side-effects were common but transient and in no case did captopril have to be withdrawn. We confirm our earlier conclusion that captopril has long-term beneficial effects and is a highly effective drug in the treatment of patients with CHF refractory to currently accepted therapy. Sudden death despite satisfactory clinical improvement continues to cause concern. Precautions which may reduce or avoid these are briefly discussed.
在两年时间里（3至24个月，平均8.6±7.7个月），对50例重度充血性心力衰竭（CHF）患者使用口服血管紧张素转换酶抑制剂卡托普利（开博通；施贵宝公司生产）进行治疗。入组时，尽管给予了大剂量利尿剂和传统血管扩张剂治疗，但所有患者均处于纽约心脏协会（NYHA）心功能IV级。6个月和12个月时的总体累积生存率分别为64%和53%。共有22例死亡（卡托普利治疗期间18例），其中包括8例猝死。在2年随访时（平均14.6±6.9个月），有25例患者继续服用卡托普利存活；其中18例处于NYHA I级或II级，7例处于IIM级或III级。所有患者的利尿剂需求量均大幅减少。副作用常见但为一过性，无一例因副作用而停用卡托普利。我们证实了我们之前的结论，即卡托普利具有长期有益作用，是治疗目前公认治疗方案难治的CHF患者的高效药物。尽管临床症状改善良好，但猝死仍令人担忧。本文简要讨论了可能减少或避免猝死的预防措施。
