伊伐布雷定对慢性阻塞性肺疾病所致慢性肺源性心脏病失代偿期患者心肺功能的影响

Effects of Ivabradine on cardiopulmonary function in patients with cor pulmonale caused by chronic obstructive pulmonary disease

目的观察伊伐布雷定对慢性阻塞性肺疾病(COPD)所致慢性肺源性心脏病失代偿期患者心肺功能的影响。方法62例COPD所致慢性肺源性心脏病患者随机分为常规治疗组及伊伐布雷定组,进行常规抗心衰治疗或联合伊伐布雷定治疗3个月,记录治疗前后NT-proBNP、hs-CRP、PCT、肺功能、COPD评估测试(CAT)、6min步行试验距离、超声心动图(LVEF、SV、RVD)、24h平均心率等。结果两组患者治疗前一般情况比较未见统计学差异。治疗后,伊伐布雷定组患者6min步行试验距离从(276.7±78.2)m上升至(341.3±55.4)m;CAT评分从21.3±5.6下降至14.2±4.1;NT-proBNP从(1425.8±502.3)pg/ml下降至(846.3±214.1)pg/ml;较常规治疗组明显降低;24h平均心率从(95.3±10.6)次/min下降至(72.1±9.4)次/min;两组差异具有统计学意义(P<0.05);hs-CRP、PCT、肺功能指标(PEF、FEV1%pred、FEV1/FVC%)、LVEF、sv、RVD比较未见统计学差异(P>0.05)。结论应用伊伐布雷定3个月对COPD所致肺心病患者,可减慢患者心率,提高运动耐量及生活质量,但对患者肺功能及心脏结构改变无影响。

Objective To observe the effect of Ivabradine on cardiopulmonary function in patients with cor pulmonale caused by COPD.Methods Sixty-two patients with chronic pulmonary heart disease were randomly divided into the routine-treatment group and Ivabradine group.The patients were treated with conventional Anti-heart failure treatment or combined with Ivabradine for 3 months.NT-proBNP,hs-CRP,PCT, lung function,COPD assessment test (CAT),6-minute walking distance (6MWD),cardiac ultrasound (LVEF, SV,RVD)and average heart rate of all the patients were measured and rekorded.Results There was no significant difference between the two groups before treatment.After treatment,the 6 MWD of the ivabradine group increased fi'om (276.7±78.2)m to (341.3±55.4)m;the CAT score decreased from 21.3±5.6to 14.2±4.1; NT-proBNP decreased from (1425.8±502.3)μg/ml to (846.3±214.1)μg/ml;significantly lower than that of the conventional treatment group.The 24-hour average heart rate decreased from (95.3±10.6)times/min to (72.1±9.4) times/min.There was significant difference with the conventional group (P<0.05).However,there were no significant differences in the changes of hs-CRP,PCT and pulmonary function (PEF,FEV1% pred,FEV1/ FVC),LVEF,SV and RVD (P>0.05).Conclusion After treatment of Ivabradine for 3 months,it is possible to improve cardiac function,exercise tolerance and quality of life in patients with pulmonary heart disease caused by COPD.It has no effect on lung function and cardiac structural change.