伊伐布雷定用于稳定型心绞痛合并慢性阻塞性肺疾病患者的疗效评价

Clinical efficacy evaluation of ivabradine in treatment of patients with stable angina pectoris complicated with chronic obstructive pulmonary disease

目的评价伊伐布雷定用于稳定型心绞痛(SAP)合并慢性阻塞性肺疾病(COPD)患者的疗效及安全性。方法选择SAP合并COPD患者80例,按照数字表法随机分成两组(均n=40),对照组患者给予常规药物治疗,观察组患者在常规药物治疗基础上联合伊伐布雷定(5 mg,bid)治疗,两组均于治疗前及治疗后1周、4周、12周分别检测两组患者的静息心率、血清儿茶酚胺水平、每周心绞痛发作次数,每次心绞痛持续时间、Borg呼吸困难评分和6 min步行距离(6MWD),并监测药物不良反应,统计美托洛尔应用人数及日用量。结果治疗12周后,观察组患者疗效优于对照组,但无显著差异(P>0.05)。治疗1周、4周、12周后,两组患者静息心率、血清儿茶酚胺水平、每周心绞痛发作次数、每次心绞痛持续时间较治疗前呈下降趋势,6MWD较治疗前呈升高趋势,而观察组患者的上述指标改善更显著(均P<0.05)。两组患者用药前后Borg呼吸困难评分比较,差异均无显著意义(P>0.05)。观察组应用美托洛尔人数和日用量显著少于对照组(P<0.01)。观察组患者不良反应发生率低于对照组(P=0.022)。结论伊伐布雷定治疗SAP合并COPD患者安全有效,可显著降低患者心率,减少心绞痛发作,增加运动耐量,不增加Borg呼吸困难评分,减少美托洛尔用量,降低血清儿茶酚胺水平。

AIM To evaluate the clinical efficacy and safety of ivabradine in the treatment of patients with stable angina pectoris （SAP） complicated with chronic obstructive pulmonary disease （COPD）. METHODS Eighty patients with SAP complicated with COPD were selected and randomly divided into two groups in accordance with the number table method, 40 patients in each group. The patients in the control group were only accepted conventional medicine. The patients in the observation group were accepted conventional medicine plus ivabradine （5 mg, bid）. Resting heart rate, serum levels of norepinephrine and epinephrine, weekly anginal attacks, each angina duration, Borg dyspnea score and 6 min walking distance （6MWD） were detected in two groups before treatment and at 1, 4, 12 weeks after the treatment. The adverse drug reactions were monitored and the number and daily dosage of metoprolol were counted. RESULTS The curative effect in the observation group was better than that in the control group after 12 weeks （P 〉 0.05）. Compared with before the treatment, resting heart rate, serum levels of norepinephrine and epinephrine, weekly anginal attacks, each angina duration, Borg dyspnea score were showed an upward tendency in two groups at 1, 4, 12 weeks, while the above indexes in the observation group were more significantly improved （P 〈 0.01 ）. There were no significant differences of Borg dyspnea score between the two groups before and after the treatment （P 〉 0.05）. The number of metoprolol patients and the daily dosage of metoprolol in the observation group were significantly less than that in the control group （P 〈 0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group （P = 0.022）. CONCLUSION Ivabradine is safe and effective for the patients with SAP with COPD, which can significantly reduce the heart rate, reduce angina pectoris and metoprolol dosage, increase exercise tolerance, decrease serum catecholamine levels and don＇t increase Borg dyspnea score.