伊伐布雷定在急性前壁心肌梗死患者中的早期应用探索

Early use of ivabradine in patient with acute anterior myocardial infarction

目的:探索伊伐布雷定在急性前壁心肌梗死患者中早期应用的有效性和安全性。方法:选取20例急性前壁心肌梗死且成功施行直接经皮冠状动脉介入(PPCI)治疗的患者,所有患者均为窦性心律且静息心率>80次/min,收缩压>90 mm Hg,射血分数<50%。患者均在接受标准的急性心肌梗死药物治疗的基础上,院内早期联合应用伊伐布雷定(起始剂量5 mg,2次/d),比较患者入院时、出院前以及术后6个月时的心率、血压、射血分数变化,并观察不良反应发生的情况。结果:20例患者中,男性占75%(15例),平均年龄(56.8±15.5)岁。50%患者合并高血压病,55%患者有吸烟史,15%患者合并糖尿病,25%患者合并慢性阻塞性肺疾病,20%患者合并慢性肾功能不全。入院时平均心率(89.4±4.9)次/min,收缩压(121.6±18.1)mm Hg,舒张压(74.9±9.7)mm Hg,射血分数(38.7±4.0)%。12例(60%)患者在PPCI术后第2天加用伊伐布雷定。出院前心率比入院时降低[(75.9±5.3)次/min vs(89.4±4.9)次/min,P<0.01],术后6个月心率比出院前降低[(67.2±5.3)次/min vs(75.9±5.3)次/min,P<0.01],术后6个月射血分数较入院时显著提升[(45.0±5.5)%vs(38.7±4.0)%,P<0.01]。收缩压和舒张压在各时段无明显变化(均P>0.05)。观察期间未发生药物相关不良反应。结论:伊伐布雷定在急性前壁心肌梗死患者中早期应用有效、安全,尤其适用于合并心功能不全和/或β受体阻滞剂不能耐受的患者,其远期疗效和安全性需进一步观察。

Objective:To evaluate the efficacy and safety of early use of ivabradine in patients with acute anterior myocardial infarction(AMI).Methods:20 patients with AMI received treatment with primary percutaneous coronary intervention(PPCI).All patients were characteristic of sinus rhythm with resting heart rate(HR)>80 beats/min,systolic pressure>90 mm Hg and ejection fraction(EF)<50%.In addition to the fundamental AMI medical treatment,ivabradine(initial dose-5 mg twice daily)was also administered.Data about the HR,blood pressure(BP)and EF at three periods were compared:on admission,at discharge and 6 months after AMI.Side effects were also evaluated.Results:In 20 patients,the males accounted for 75%with the average age of 56.8±15.5 years old.Hypertension was present in 50%,smoking in55%,diabetes mellitus in 15%,COPD in 25%,and renal insufficiency in 20%patients.The average HR on admission was 89.4±4.9 beats/min,and the systolic BP,diastolic BP and EF were(121.6±18.1)mm Hg,(74.9±9.7)mm Hg and 38.7%±4.0%respectively.The HR at discharge was significantly lower than that on admission(P<0.001).At 6 th month after AMI,the HR was also significantly lower than that at discharge(P<0.001).The EF significantly increased at6 th month after admission.There were no significant changes in the systolic and diastolic BP during the study period(P>0.05).No medicine-related side effect was observed during the follow-up period.Conclusion:The early application of ivabradine in anterior AMI is effective and safe,especially for the AMI patients who are not able to tolerate beta blockers and/or accompanied by cardiac dysfunction.It remains to be further observed in regard to its long-term effectiveness and safety.