卡维地洛对冠心病无症状心肌缺血及心率变异性的影响

Therapeutic Efficacy of Carvedilol on Silent Myocardial Ischemia and Heart Rate Variability in Coronary Heart Disease

目的探讨卡维地洛对冠心病无症状心肌缺血及心率变异性(HRV)的影响。方法随机将78例冠心病心肌缺血患者分为2组,治疗组40例,对照组38例。治疗组在应用常规药物阿司匹林、普伐他汀基础上加用卡维地洛片,bid。第1周每次5 mg,第2周每次7.5 mg,第3周增至每次10 mg。对照组应用常规药物阿司匹林、普伐他汀联合硝酸异山梨酯片,tid,每次10 mg。治疗前后进行动态心电图检测,对缺血及HRV的相关指标作对比观察。结果治疗12周后,两组有症状的和无症状的ST段压低次数及其持续时间均有明显减少及缩短,与治疗前比较,差异均有极显著性或显著性(P<0.01或P<0.05)。治疗组疗效明显优于对照组(P<0.05)。同时,治疗组HRV指标[SDNN(24 h全部窦性R-R间期的标准差),SDANN(24 h内每5 min窦性R-R间期平均值的标准差),SDNNindex(24 h每5 min窦性R-R间期标准差的平均值)]亦明显改善(均P<0.01),但对照组治疗前后HRV各指标差异无显著性(P>0.05)。卡维地洛治疗期间,患者无严重不良反应。结论卡维地洛不仅对冠心病无症状心肌缺血有显著疗效,且能改善HRV。

Objective To explore the therapeutic efficacy of carvedilol on silent myocardial ischemic （SMI） and heart rate variability （HRV） in coronary heart disease. Methods Seventy-eight cases of coronary heart disease were randomly divided into treatment group （40 cases） and control group （38 cases）. Control group was treated with aspirin, pravastatin and sorbitrate, and treatment group was treated with carvedilol based on aspirin and pravastatin. The changes in SMI and HRV were observed by Dynamic electrocardiolgram before and 12 weeks after treatment. Results Frequency and sustained time of symptomatic and asymtomatic myocardral ischemia were decreased significantly in two groups （ P 〈 0. 01 and P 〈 0. 05, respectively） after treatment, but more significantly （ P 〈 0.05 ） in treatment group than in control group. HRV parameters （SDNN,SDANN, SDNNindex） were significantly improved （P 〈 0.01 ） in the treatment group , but there were not different （P 〉 0.05 ） in control group before and after treatment. No side effects were found in treatment with carvedilol. Conclusion There is significant therapeutic efficacy of carvedilol on SMI and HRV in coronary heart disease.