选择性与非选择性β受体阻滞剂对老年冠心病的治疗价值及对心率变异性影响的对比研究

Parallel study on treatment value and variety of heart rate variability after cardioselective beta-blocker,and non-cardioselective beta-blocker therapy in older patients with coronary artery disease

目的:探讨选择性β受体阻滞剂与非选择性β受体阻滞剂对老年冠心病的治疗价值及对心率变异性的影响。方法:应用选择性β受体阻滞剂比索洛尔与非选择性β受体阻滞剂卡维地洛治疗老年性冠心病52例,用三通道动态心电图进行24h监测,同时进行心率变异性分析。结果:应用比索洛尔和卡维地洛治疗12周后,比索洛尔和卡维地洛均可减少心肌缺血次数和时间,增加24h平均正常心动周期(NN)间期,只有比索洛尔引起迷走张力活动增加,PNN50与rMSSD均增加(P<0.05)。比索洛尔不引起SDNN和SDANN的明显改变,而卡维地洛却减少SDNN和SDANN(P<0.05)。结论:比索洛尔和卡维地洛均可以减少心肌缺血次数和时间,增加24h平均正常NN间期;非选择性β受体阻滞剂卡维地洛因可降低HRV的参数SDNN和SDANN,有可能增加心性猝死率和心血管事件的发生率。而选择性β受体阻滞剂比索洛尔可增加迷走张力,明显改善心率变异性,有可能减少心性猝死率和心血管事件的发生率。作者认为,对于老年冠心病心肌缺血的患者,尤其同时伴有心率变异性减低着,若是β受体阻滞剂治疗的适应证,以选择性β受体阻滞剂为宜。

Objective To study the treatment value and variety of heart rate variability after bisoprolol and carvedilol therapy for the older coronary artery disease. Methods Fifty-two patients with older coronary heart disease were randomly assigned to either bisoprolol, a cardioselective beta-blocker, carvedilol, a beta-blocker with vasodilator properties, monitored by 24 hours dynamic electrocardiogram, analyzed by heart rate variability. Results After 12 weeks treatment, both bisoprolol and carvedilol decreased the ischemical numbers and times, increased 24-hour average normal RR. Measures of tonic vagal activity were increased significantly only with bisoprolol, the percentage of differences 〉50 msec between adjacent NN intervals（PNN50 ）and root mean square successive differences （rMSSD） were increased significantly （P〈 0. 05）. By contrast, standard deviations （SD） of all NN over a 24-hour period（SDNN） and SD of means of 5-minute blocks of NN related to total（SDANN） were significantly decreased by carvedilol （P〈0. 05）but not significantly modified by bisoprolol （P〈0. 05）. Conclusion SDNN and SDANN are significantly decreased by carvedilol. The carvedilol will increase the possibility of sudden death and cardiovascular events. Measures of tonic vagal activity are increased significantly only with bisoprolol. So bisoprolol will decrease the possibility of sudden death and cardiovascular events. It is suggested that myocardial ischemia of the older coronary artery disease with heart rate variability decreasing should be treated by cardioselective beta-blocker.