卡维地洛对慢性充血性心力衰竭患者心功能及心率变异性的影响

Effect of carvedilol on cardiac function and heart rate variability in patients with congestive heart failure

目的观察卡维地洛对慢性充血性心力衰竭(CHF)患者心功能和心率变异性(HRV)影响。方法46例CHF患者随机分对照组和治疗组,对照组22例常规用血管紧张素抑制剂和利尿剂,治疗组24例在对照组常规用药的基础上联用小剂量卡维地洛,逐步加量至目标剂量治疗8个月。测定治疗前后心功能和HRV。结果治疗组较对照组显著降低心率和血压,缩短左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、提高左室射血分数(LVEF)及E/A值(P<0.001),改善左室收缩和舒张功能;其HRV时域指标24h窦性心律RR间期标准差(SDNN),24h相邻RR间期差值均方根(rMSSD),频域指标低频率段功率(0.04～0.15Hz)(LF)和高频率段功率(0.15～0.40Hz)(HF)有显著差异(P<0.05)。结论卡维地洛能进一步减轻心脏负荷,改善心室重塑,改善自主神经调节能力。

Objective To study the effect of carvedilol on cardiac function and heart rate variability(HRV) in patients with congestive heart failure (CHF).Methods Forty-six CHF patients were randomly divided into two groups,carvedilol group (24 patients) was treated with carvedilol from low dose to target dose in addit ion to standard therapy for CHF.The routingly treatment group (22 patients) was treated with standard therapy for CHF.The cardiac fuction and HRV of all patients were examined before and after 8-months therapy.Results Heart rate(HR),blood pressure (BP),left ventricle(LV) end-diastolic dimension(LVEDD),LV end-systolic dimension(LVESD) in carvedilol group were significantly lower than those in control group(P<0.01).The LV ejection fraction(LVEF) and E/A were significantly higher than those in control group(P<0.01).After treatment,standard deviation of means R-R intervals all over 24 h(SDNN),root-mean-square deviation of successive R-R intervals (rMSSD),low frequency(LF),high frequency(HF) in carvedilol group were obviously higher than those in control group(P<0.01).Conclusion Carvedilol may relieve cardiac load and improve ventricle reconstruction and regulation of autonomicnerve.