硫酸氢伊伐布雷定联合康复运动对老年心力衰竭患者心功能及心肌重构相关因子影响

Effect of ivabradine hydrosulfide combined with rehabilitation exercise on heart function and related factors of myocardial remodeling in elderly patients with heart failure

目的探讨硫酸氢伊伐布雷定联合康复运动对老年心力衰竭患者心功能及心肌重构相关因子的影响。方法选取2015年8月~2017年8月在沈阳市第十人民医院进行治疗的老年慢性心力衰竭(HF)患者150例,采用随机数字表法分为观察组和对照组,每组各75例,其中对照组在原有抗HF药物治疗基础上加服硫酸氢伊伐布雷定缓释片,观察组在对照组基础上进行康复训练。观察治疗前后患者左心室射血分数(LVEF)、左心室收缩末期内径(LVESd)及左心室舒张末期内径(LVEDd)状况,患者神经激素系统相关指标改变状况,包括B型钠尿肽(BNP)、肾素活性(PRA)、醛固酮(ALD)及血管紧张素Ⅰ(AngⅠ)含量状况,观察患者6min步行试验(6MWT)状况及不良反应情况。结果治疗后,观察组LVEF(40.12±3.86)较对照组(37.21±3.52)、治疗前(35.10±3.16)显著升高,观察组LVESd(49.86±2.36)较对照组(52.97±2.52)、治疗前(55.03±3.10)显著降低,差异均有统计学意义(P<0.05);治疗后,观察组患者血清ALD、BNP、PRA及AngⅠ含量较治疗前、对照组显著降低,差异有统计学意义(P<0.05);治疗后,观察组6MWT结果是(344.59±48.19)m,对照组为(315.17±48.20)m,差异有统计学意义(P<0.05)。结论硫酸氢伊伐布雷定联合康复运动可改善患者心室收缩功能,对患者心肌重构也有改善作用。

Objective To analyze the effects of ivabradine and rehabilitation exercise on cardiac function and myocardial remodeling related factors in elderly patients with heart failure. Methods A total of 150 elderly patients with chronic heart failure (HF) who were treated in our hospital between August 2015 and August 2017 were randomly divided into two groups by the random number table method. The control group(75 cases) was originally treated with anti-HF. On the basis of drugs,ivabradine sulphate tablets and exercise training were added in the observation group(75 cases).Left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESd), left ventricular end-diastolic diameter(LVEDd), and serum B-type natriuretic peptide(BNP),renin activity(PRA),aldosterone(ALD),and angiotensin I (AngI) content were observed before and after treatment. 6-minute walking test(6MWT)was taken before and after treatment. Results LVEF in the observation group was significantly higher after treatment than before treatment, and after treatment LVEF in the observation group was higher than that in the control group(P < 0.05). LVESd in the observation group was significantly lower after treatment than before treatment, and after treatment LVESd in the observation group was lower than that in the control group. Serum ALD,BNP, PRA and AngI were significantly lower after treatment than before treatment, and after treatment serum ALD,BNP, PRA and AngI in the observation group was lower than those in the control group.(all P < 0.05). After treatment,the distance of 6MWT in the observation group was (344.59 ± 48.19) m and the distance of 6MWT in the control group was(315.17 ± 48.20) m, and there was statistical significance(P < 0.05). Conclusion The combination of Ivabradine H2SO4 and rehabilitation exercise can improve the ventricular systolic function and improve the myocardial remodeling.