摘要(Abstract)：

<正> The 5-year-survival rate for patients with severe congestive beart failure(CHF)isapproximately 50% for those judsed to be in New Yock Heart Associstion(NYHA)class Ⅲ;for patients in classⅣ;the 5-year-survial rate decilimes to about 20%,fatal of136-impstients(89 men and 47 women)were enrolled,mean age was 68 years(range39-84 year)and the mean duration of heart faihure was 26 months(range 3-32months).the primary etiologic factor was ischemic heart disease in 92patients,hypertension in 26.dilated cardiomyopathy in 14,and mitral insufficiency in4.short and long-term clinical effects of the anglotensin-converting enzyme(ACE)inhibtor enalapril in severe congesttive heat failure(CHF)were evaluated during a 2-year open study of 136 inpatients with New York Heart Association(NRHA)funtional class Ⅲ or Ⅳ CHF refractory to treatment with cardial glycosides andhigh doses of loop dluretics,Enalapr was added to each petients reglmen,whichcomprised combinations of urosomide(136patients),digitalis(102patients),andspironolactone(89pstients),By the end of the first month of Enalapriladrninistration,improvement in NRHA functional class was seen in 89 patients(72%).During the first year of Enalapril treatment,the number of hospital admissionsand hospital days delined signiflcantly(p<0.001)and functional class improvedsigniflcantly(p<0.001).Although most patients to lerated Enalapric well..44%experiencde hypotension,which in 10% of patients necessited termination ofEnalapril therapy.Although mean serum potassium levels traded to increase,serioushyperkalemia did not occur,After 1 year,a subset of 30 patients who had not initiallyrecelved spironolactone detersted clinically and manfested inreasing urinaryaldosterone leveis.Hypotension precluded increasing the Enalapril dose,butintroduction of spiroonolsctone improve dclinical status in this cohort.The resuitssaggest that rational therapy for severe CHF.In cludss,addition of the aldosteroneantagonist spironactone to low doses of Enalapril(or abother ACE inhibitor)andhigh doses of loop dluretlcs provided rebal function is adequate.

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