基于心率变异性、心室晚电位评价温胆片对频发室性早搏的治疗作用

Effects of Wendan Tablets on Heart Rate Variability and Ventricular Late Potential in Frequent Ventricular Premature Beats

目的观察温胆片对频发室性早搏病人心率变异性(HRV)、心室晚电位(VLP)的影响,评价其治疗室性早搏的临床疗效。方法 60例符合24h动态心电图诊断的频发室性早搏病人,随机分为治疗组及对照组,每组30例。治疗组以温胆片(4粒,每日3次)口服,对照组以美托洛尔(25mg,每日2次),疗程4周,对比两组治疗前后HRV指标变化,包括时域指标(SDNN、rMSSD、pNN50)和频域指标(LF、HF、LH/HF);观察两组治疗前后VLP指标变化(包括TQRS、LAS40、RMS40)及VLP阳性患者的转阴率。结果与治疗前相比,两组治疗后SDNN、rMSSD、pNN50、HF均有显著升高(P<0.05或P<0.01),LF、LF/HF则明显降低(P<0.05)。治疗后,TQRS、LAS40较前缩短,而RMS40较前增高(P<0.05),治疗组及对照组对频发室性早搏VLP阳性患者转阴率分别为57.1%和75.0%。治疗组与对照组治疗室性早搏总有效率分别为70.0%和66.7%。结论温胆片能有效治疗频发室性早搏,其不仅可以改善心率变异性,而且可以通过缩短TQRS、LAS,提高RMS对VLP阳性病人有一定的转阴作用而改善频发室性早搏病人的预后,推测其机制可能同提高心脏迷走神经张力,抑制交感神经张力,改善心脏自主神经失衡状态有关。

Objective To investigate the effects of Wendan tablets(WDT)on heart rate variability(HRV),ventricular late potential(VLP)in patients with frequent ventricular premature beats(FPVB).Methods Sixty patients with FPVB diagnosed by Holter were randomizedly divided into two groups:Treatment group(n=30)treated by WDT(4tablets,3times a day),and control group(n= 30)treated by betaloc(25mg,twice a day).SDNN,rMSSD,pNN50and LF,HF,LH/HF,TQRS,LAS40,and RMS40were analyzed before and after treatment.Results After treatment,the SDNN,rMSSD,pNN50,HF were improved significantly in two groups(P<0.05 or P<0.01),and the LF and LF/HF were decreased significantly(P<0.05).TQRS,LAS40were shorten and the RMS40was increased than before in the two groups(P<0.05).The negative rate in patients with FPVB(VLP+)was 57.1%in treatment group, and that in control group was 75%.The total efficiency of FPVB was 70%in the treatment group,and that in control group was 66.7%. Conclusion WDT could effectively reduce the FPVB.It could increase the HRV,reduce the positive rate of VLP in FPVB patients, and improve the prognosis.The mechanism might be related to improve cardiac vagal tone,inhibit sympathetic tone,and improve the state of imbalance of cardiac autonomic nervous system.