伊伐布雷定联合比索洛尔对冠心病PCI术后患者心脏康复的影响

The effect of ivabradine combined with bisoprolol on rehabilitation of patients with coronary heart disease after percutaneous coronary intervention

目的:研究伊伐布雷定联合比索洛尔对冠心病经皮冠状动脉介入(PCI)术后患者心脏康复的影响。方法:选取于某院行PCI术的冠心病患者84例,随机分为观察组(n=42)及对照组(n=42),观察组在常规冠心病二级预防治疗的基础上给予比索洛尔1.25 mg联合伊伐布雷定治疗,对照组在常规冠心病二级预防治疗的基础上仅给予比索洛尔5~10 mg口服。分别于治疗前、治疗4周及治疗12周时监测两组患者的6 min步行实验的距离、6 min步行实验的心率及血氧饱和度、左室射血分数、左室收缩末期内径、左室舒张末期内径、左室间隔厚度及左心室壁厚度。结果:观察组与对照组比较,在治疗12周时,6min步行试验的距离、LVEF及左室正常舒张功能的比例明显增加,LVEDD、LVESD及6 min步行实验时的心室率明显降低,差异均具有统计学意义(P<0.05);与治疗前相比,在治疗4周及12周时,观察组的6 min步行试验的距离、LVEF及左室正常舒张功能的比例明显增加,LVEDD、LVESD及6 min步行实验时的心室率明显降低,差异均具有统计学意义(P<0.05);研究期间,观察组不良反应发生率低于对照组,但无统计学差异(P>0.05)。结论:伊伐布雷定联合比索洛尔对冠心病PCI术后患者的心脏康复的长期效果优于单纯比索洛尔治疗,不增加不良反应,是一种安全有效的治疗方案。

OBJECTIVE To discuss the effects of ivabradine combined with bisoprolol on cardiac rehabilitation in patients with coronary heart disease after percutaneous coronary intervention （PCI）. METHODS Eighty four patients with coronary heart disease in our hospital after PCI were randomly divided into observation group （n = 42） and control group （n = 42）. Pa tients in observation group received bisoprolol tablets 1.25 mg combined with ivabradine on the basis of conventional treatment of secondary prevention of conventional coronary heart disease. Patients in control group received 5 10 mg bisoprolol on the ba- sis of conventional treatment of secondary prevention of conventional coronary heart disease. The distance in 6 minute walk test, heart rate and blood oxygen saturation in 6 minute walking test, left ventricular ejection fraction, left ventricular end sys- tolic diameter, left ventricular end diastolic diameter, left ventricular septal thickness and left ventricular wall thickness were monitored before treatment, at 4 weeks and 12 weeks of treatment, RESULTS Compared to control group, at 4 and 12 weeks of treatment, the distance in 6 minute walk test, LVEF and the proportion of normal diastolic function were significantly in- creased （P〈0. 05）, LVEDD, LVESD and the ventricular rate in 6 minutes walking test were significantly decreased （P〈0. 05） in observation group. Compared to those before treatment, at 4 and 12 weeks of treatment, in the observation group, the dis- tance in 6 minute walk test, LVEF and the proportion of normal diastolic function were significantly increased （P〈0. 05）, LVEDD, LVESD and the ventricular rate in 6 minutes walking test were significantly decreased （P〈0. 05）. The incidences of adverse reactions in the observation group were lower than those of the control group, but there was no significant difference （P〈0. 05）. CONCLUSION Ivabradine combined with a low dose of bisoprolol has a better effect on cardiac rehabilitation in patients with coronary heart disease after PCI than bisoprolol, and do not increase adverse reactions. It is a safe and effective treatment.