缺血性心肌病心力衰竭患者心脏收缩和舒张功能及其再住院率与曲美他嗪的干预效应

Effect of rimetazidine on the systolic and diastolic functions and the rate of rehospitalization in patients with congestive heart failure due to ischemic cardiomyopathy

目的:观察曲美他嗪对缺血性心肌病心力衰竭患者心脏收缩和舒张的影响,并分析1年内再住院率情况。方法:选择2003-01/2004-01哈尔滨医科大学第一临床医学院心内科门诊及住院缺血性心肌病患者168例,全部病例均符合世界卫生组织1979年冠心病缺血性心肌病的诊断标准,并自愿参加研究,男86例,女82例,平均年龄(59±13)岁,心力衰竭的诊断标准按照纽约心脏病学会(NYHA)分级标准为Ⅱ～Ⅳ级。曲美他溱治疗组在常规治疗基础上给予曲美他嗪治疗;常规治疗组给予常规药物治疗。采用超声于治疗前、后4周、1年测定两组的心搏出量,心脏指数,左室射血分数,E峰和A峰流速比值(E/A),等容舒张时间,随访1年内两组再住院例次。结果:治疗后4周曲美他嗪治疗组和常规治疗组无脱落。治疗后1年曲美他嗪治疗组、常规治疗组因死亡各脱落3,15例,进入结果分析例数分别为83,67例。治疗后4周曲美他嗪治疗组患者心搏出量、心脏指数、左室射血分数、E峰与A峰流速比值[(58.6±10.2)mL,(4.4±0.6)L/(min.m2),(38.6±10.8)%,(0.82±0.2)cm/s]明显高于治疗前[(52.3±11.4)mL,(3.1±0.7)L/(min.m2),(34.8±7.6)%,(0.69±0.1)cm/s,t=2.48～2.98,P<0.05]。等容舒张时间[(122.5±21.6)ms]明显短于治疗前[(158.3±29.2)ms,(t=2.56,P<0.05)]。治疗后1年曲美他嗪治疗组患者心搏出量、心脏指数、左室射血分数、E峰与A峰流速比值[(76.9±16.8)mL,(5.6±1.1)L/(min.m2),(54.2±14.2)%,(1.38±0.6)cm/s]明显高于治疗前及常规治疗组[(60.4±11.8)mL,(3.5±0.8)L/(min.m2),(36.1±8.2)%,(0.70±0.4)cm/s,t=2.36～2.78,P<0.05],等容舒张时间[(88.4±24.5)ms]明显短于治疗前及常规治疗组[(155.8±30.2)ms,t=2.56,2.89,P<0.05]。曲美他嗪治疗组1年内再住院10例次,再住院率12%(10/86),常规治疗组31例次,再住院率38%(31/82),两组差异明显(χ2=114.21,112.86,P<0.05)。结论:在缺血性心肌病心力衰竭的康复治疗中长期使用曲美他嗪可改善心脏收缩及舒张功能,明显改善患者预后功能而降低再住院率。

AIM:To observe the influence of trimetazidine on the systolic and diastolic functions of patients with congestive heart failure of ischemic cardiomyopathy,and analyze the rate of rehospitalization in one year. METHODS:Total of 168 ICM patients(86 males and 82 females),averagely at(59±13) years of age,were selected from those who were treated or hospitalized in the Department of Cardiology,First Clinical Medical College of Harbin Medical University from January 2003 to January 2004.All the cases met the diagnostic criteria of coronary heart disease and ischemic cardiomyopathy by WHO in 1979,and participated in the study voluntarily,the diagnostic criteria of chronic heart failure was according to grade Ⅱ to Ⅳ with the classifying standard of New York Heart Association(NYHA).Regular drug therapy was given to patients in both regular treatment group and trimetazidine treated group,beside trimetazidine was applied to those in the latter group.Clinical curative effects were evaluated before treatment and 4 weeks later,left ventricular cardiac stroke volume,cardiac index,left ventricular ejection fraction,flow-rate ratio of E peak to A peak and isometric relaxation time were measured with ultrasound in both groups before treatment and 4 weeks and one year after treatment,and the number of rehospitalized cases within the one-year follow-up was investigated. RESULTS:Four weeks after treatment,no one lost in both groups.One year after treatment,3 and 15 cases lost in the trimetazidine treated group and regular treatment group respectively,and 83 and 67 cases were involved in the analysis of results.Four weeks after treatment in the trimetazidine treated group,stroke volume,cardiac index,left ventricular ejection fraction,flow-rate ratio of E peak to A peak[(58.6±10.2) mL,(4.4±0.6) L/m2 per minute,(38.6±10.8)%,(0.82±0.2) cm/s] were obviously higher than those befor treatment[(52.3±11.4)mL,(3.1±0.7)L/m2 per minute,(34.8±7.6)%,(0.69 ±0.1) cm/s](t=2.48 to 2.98,P< 0.05),ismetric relaxation time[(122.5 ±21.6)ms] was markedly shorter than that before treatment[(158.3±29.2) ms](t=2.56,P< 0.05). One year after treatment in the trimetazidine treated group,stroke volume,cardiac index,left ventricular ejection fraction,flow-rate ratio of E peak to A peak[(76.9±16.8)mL,(5.6±1.1) L/m2 per minute,(54.2 ±14.2)%,(1.38±0.6)cm/s] were remarkably higher than those before treatment and those in the regular treatment group [(60.4±11.8) mL,(3.5±0.8) L/m2 per minute,(36.1±8.2)%,(0.70±0.4) cm/s](t=2.36 to 2.78,P< 0.05),ismetric relaxation time was markedly shorter than that before treatment and that in the regular treatment group [(155.8±30.2) ms](t =2.56,2.89,P< 0.05).One year after treatment,there was obvious difference in the number of rehospitalized cases and rate of rehospitalization between the trimetazidine treated group(12%,10/86) and regular treatment group(38%,31/82)(χ2=114.21,112.86,P< 0.05). CONCLUSION:In the rehabilitative treatment of patients with chronic heart failure of ischemic cardiomyopathy,trimetazidine can improve cardiac systolic and diastolic functions, ameliorate their prognosis of function and reduce the rate of rehospitalization.