静息心率对慢性心力衰竭合并高血压患者心功能及预后的影响

Relationship between the resting heart rate on admission and prognosis of heart function in chronic heart failure patients with hypertension

目的探讨静息心率(resting heart rate,RHR)与慢性心力衰竭合并高血压患者心功能及预后的关系。方法 2016年9月至2017年8月于保定市第一中心医院心内科因慢性心力衰竭住院的高血压患者250例,按入院RHR水平分为3组:RHR1组,RHR<70次/min;RHR2组,70次/min≤RHR<90次/min;RHR3组,RHR≥90次/min。测量患者超声心动图参数,包括左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)和左心室射血分数(left ventricular ejection fraction,LVEF),按照纽约心脏病协会(NYHA)分级情况对患者入院、出院及随访时的心功能进行评估并记录,对比各组之间各项指标及疗效的差异,并分析其相关性。结果随着入院RHR的升高,LVEF呈现逐渐降低的趋势(P <0.05),而LVEDD、B型脑钠肽(BNP)均逐渐升高,以RHR3组最高(P <0.05);RHR1组、RHR2组出院疗效及随访疗效均优于RHR3组(P <0.05);RHR3组入院RHR水平与出院疗效呈负相关(r=-0.251,P均<0.05);RHR2组、RHR3组(入院-出院)RHR差值与出院疗效、随访疗效均呈正相关(其与出院疗效相关性r值分别为0.197、0.279,其与随访疗效相关性的r值分别为0.214、0.321,P均<0.05)。结论对于慢性心力衰竭合并高血压的患者,静息心率水平越高,左心功能越差,出院疗效及随访疗效也越差,积极合理的控制RHR有助于改善预后。

Objective To analyze the relationship between the resting heart rate(RHR)on admission and prognosis of heart function in chronic heart failure patients with hypertension.Methods All 250 chronic heart failure patients with hypertension were divided into three groups according to the levels of RHR on admission:RHR1 group,RHR<70 beats/minute(bpm);RHR2 group,70 bpm ≤ RHR < 90 bpm;RHR3 group,RHR ≥ 90 bpm.Echocardiographic parameters including left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured,and the prognosis of heart function on admission,discharge,follow-up were collected.The differences in all indicators and curative effects were compared between groups.Results With the increase of RHR on admission,LVEF showed a decreasing trend(P <0.05),while LVEDD and BNP increased gradually,and those were the highest in RHR3 group(P <0.05).The discharge effect and follow-up effect of RHR1 group and RHR2 group were both better than those of RHR3 group(P <0.05);RHR on admission of RHR3 group was negatively correlated with discharge effect(r =-0.251,P <0.05);the difference in RHR between admission and discharge was positively correlated with both discharge effect and follow-up effect in RHR2 group and RHR3 group(associated with discharge effect[r=0.197,0.279,P <0.05],associated with follow-up effect[r=0.214,0.321,P<0.05]).Conclusion In the heart failure patients with hypertension,the faster of RHR,the lower the heart function of left heart,the worse of the discharge effect and follow-up effect.But the positive and reasonable control of heart rate is conducive to the prognosis of heart failure.