胺碘酮分别联合比索洛尔与美托洛尔治疗收缩性心力衰竭合并室性心律失常效果比较

The effect of amiodarone combined with bisoprolol and amiodarone combined with metoprolol in the treatment of congestive heart failure and ventricular arrhythmia

目的比较胺碘酮分别联合比索洛尔与美托洛尔治疗收缩性心力衰竭并室性心律失常的效果。方法选择2016年1-12月青海省心脑血管病专科医院心律失常科诊治收缩性心力衰竭并室性心律失常患者84例作为研究对象,随机数字表法分为2组,各42例。观察组给予胺碘酮联合比索洛尔治疗,对照组采用胺碘酮联合美托洛尔治疗。治疗12周后,比较2组患者心功能疗效、心律失常疗效、心率(HR)、右室射血分数(RVEF)、QT离散度(QTc)、左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)、Barthel评分及6 min步行距离。结果治疗后,观察组心功能及心律失常总有效率均高于对照组(92.86%vs.71.43%,χ~2=6.574,P=0.010;83.33%vs.57.14%,χ~2=6.891,P=0.009),HR、QTc均低于对照组(t=3.958、2.731,P=0.000、0.008),RVEF、LVEF均高于对照组(t=13.998、10.851,P=0.000、0.000);NT-proBNP及cTnⅠ水平低于对照组(t=2.699、10.247,P=0.000、0.000);Barthel评分及6 min步行距离均优于对照组(=4.197、7.960.P=0.000、0.000);在6个月随访中,观察组收缩性心力衰竭并室性心律失常复发率低于对照组[14.29%vs.2.38%,χ~2=3.8 6,P=0.048),而病死率差异无统计学意义(P>0.05)。结论胺碘酮联合比索洛尔治疗收缩性心力衰竭并室性心律失常可有效改善机体心功能,降低NT-proBNP水平,提高预后,疗效优于胺碘酮联合美托洛尔。

Objective To investigate the effect of amiodarone combined with bisoprolol and amiodarone combined with metoprolol in the treatment of congestive heart failure and ventricular arrhythmia. Methods Eitghty-four patients of congestive heart failure and ventricular arrhythmia who received therapy from Jan 2016 to Dec 2016 in our hospital were randomly divided into observation group and control group, 42 cases in each group. The observation group was treated with amiodarone combined with bisoprolol, while the control group was treated with amiodarone combined with metoprolol. After 12 weeks of treatment, the improvement of heart function and heart failure, heart rate（ HR）, right ventricular ejection fraction（ RVEF）,QTc, left ventricular ejection fraction（LVEF）, NT-proBNP, cardiac troponin I（cTn I）, Barthel score and 6 min walking distance between the two groups were compared. Results After treatment, the total effective rate of heart function and anti-arrhythmia was higher in the observation group than in the control group（92. 86% vs. 71.43%,χ^2= 6. 574, P =0. 010;83.33% vs. 57. 14%,χ^2=6. 891, P = 0. 009）; The observation group HR, QTc were lower than the control group（t =3.958,t =2. 731,P = 0.000, P = 0.008）,RVEF,LVEF were higher than the control group（t= 13.998, t=10. 851,P=0. 000, P = 0. 000）; The levels of NT-proBNP and cTn I in the observation group were lower than those in the control group（t= 2. 699,t=10. 247,P= 0. 000,P=0. 000）; The observation group ＇ s Barthel score and walking distance 6 min were better than the control group[（67. 53 ±4. 09） vs.（55. 21 ±3. 86） score,（369. 82 ±40. 21） vs.（302. 13 ±37.69） m,t=14. 197, t =7.960,P =0.000, P= 0.000）; During the 6 months follow up, the recurrence rate of congestive heart failure and ventricular arrhythmia in the observation group were lower than that in the control group（14.29 % vs. 2. 38%,χ^2=3. 896,P =0.048）. Conclusion Amiodarone combined with bisoprolol in patients with congestive heart failure and ventricular arrhythmia can effectively improve the body s heart function, reduce NT proBNP levels and improve prognosis, the effect is superior to amiodarone combined with metoprolol.