美托洛尔与伊伐布雷定联合控制心率对急诊PCI患者短期预后的影响

Effects of Metoprolol combined with Ivabradine in controlling the heart rate for the short-term prognosis of patients with emergency PCI

目的探讨美托洛尔联合伊伐布雷定对接受急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者心率控制及预后的影响。方法回顾性分析2015年7月~2017年7月武汉科技大学附属孝感市中心医院心内科收治的152例接受急诊PCI的STEMI患者的临床资料,按治疗方案分为联合治疗组(75例)和对照组(77例)。联合治疗组患者采用琥珀酸美托洛尔缓释片联合伊伐布雷定严格控制患者心率(静息心率≤65次/min),对照组患者采用琥珀酸美托洛尔缓释片控制患者心率(静息心率≤75次/min)。对所有患者进行为期1个月的随访,观察记录每位患者心率、左室射血分数(LVEF)、脑钠肽前体(NT-proBNP)及心血管事件发生情况。结果术后1个月,两组患者心率较术后第2天明显降低,LVEF及NT-proBNP水平均较术后第2天升高,差异有统计学意义(P<0.05)。术后1个月联合治疗组患者心率明显低于对照组,LVEF及NT-proBNP水平较对照组明显升高,差异有统计学意义(P<0.05)。联合治疗组随访1个月过程中再次发生心绞痛比例(4.00%比19.48%,P<0.05)、再次血运重建比例(2.67%比14.29%,P<0.05)和恶性心律失常比例(1.33%比10.39%,P<0.05)明显低于对照组。结论琥珀酸美托洛尔缓释片联合伊伐布雷定能进一步控制急诊PCI术后患者的心率,改善心功能,并能改善该类患者预后,值得临床推广。

Objective To investigate the effects of Metoprolol combined with Ivabradine for the heart rate control and short-term prognosis of patients with acute ST segment elevation myocardial infarction （STEMI） receiving emergency percutaneous coronary intervention （PCI） therapy. Methods The clinical data of 152 cases of patients with STEMI receiving emergency PCI admitted to Department of Cardiology, Xiaogan Central Hospital Affiliated to Wuhan University of Science and Technology from July 2015 to July 2017 was analyzed retrospectively, and the patients were divided into combined treatment group （75 cases） and control group （77 cases）. The combined treatment group received Metoprolol Succinate Sustained-release Tablets and Ivabradine to control heart rate strictly （resting heart rate ≤65 times/main）, control group only received Metoprolol Succinate Sustained-release Tablets to control heart rate （resting heart rate ≤ 75 times/min）. All patients Were followed up for one month, the heart rate, left ventricular ejection fraction （LVEF）, N-terminal probrain natriuretic peptide （NT-proBNP） and the occurrence of cardiovascular events of each patient were observed and recorded. Results One month after operation, the heart rate of the two groups was significantly lower than the second day after surgery, the levels of LVEF and NT-proBNP were higher than the second day after surgery, the differ- ences were statistically significant （P 〈 0.05）. One month after operation, the heart rate of patients in the combined treatment group was significantly lower than that in the control group, the levels of LVEF and NT-proBNP were significantly higher than the control group, the differences were statistically significant （P 〈 0.05）. The rates of recurrence of angina pectoris （4.00% vs. 19.48%, P 〈 0.05）, repeat revascularization （2.67% vs. 14.29%, P 〈 0.05） and malignant arrhythmia （1.33% vs. 10.39%, P 〈 0.05） of combined treatment group were significantly lower than those of control group during the follow-up period of 1 month. Conclusion Metoprolol Succinate Sustained-release Tablets combined with Ivabradine can further control the heart rate of patients with emergency PCI, improve cardiac function and the prognosis of these patients, which is worthy of clinical promotion.