伊伐布雷定在急性失代偿性收缩性心力衰竭中的应用

Application of ivabradine in patients with acute decompensated systolic heart failure

目的探讨伊伐布雷定应用于急性失代偿性收缩性心力衰竭中的有效性和安全性。方法回顾性分析2016年1月至2018年12月因急性失代偿性收缩性心力衰竭入治阳江江华医院心内科接受伊伐布雷定的32例患者病历资料,分析其入院(T1)、施与口服伊伐布雷定开始治疗前(T2)、口服伊伐布雷定24 h后(T3)、出院时(T4)4个时间点的血流动力学参数(心率、收缩压、舒张压、平均血压、血浆氨基末端脑钠肽前体、外周血血氧饱和度)、纽约心脏协会心功能分级的变化情况,以及心率和氨基末端脑钠肽前体变化的相关性。结果患者均平均服药14.59±6.31 d。治疗后,心率在T3和T4均降低。收缩压于T3时降低(P<0.05),T4时恢复到治疗初期。舒张压、平均血压和血氧饱和度变化无统计学意义(P>0.05)。出院时,纽约心脏协会心功能分级有所提高(P<0.05)。氨基末端脑钠肽前体水平与心率在T2时相关,其总降低水平与服药前后的心率水平相关。结论在心率>70 bpm的急性失代偿性收缩性心力衰竭患者中,口服伊伐布雷定选择性降低心率是安全有效的。

Objective To investigate the efficacy and safety of ivabradine in the treatment of acute decompensated systolic heart failure.Methods In Yangjiang Jianghua Hospitall,from January 2016 to December 2018,the medical records of patients who underwent acute decompensated systolic heart failure were researched by a retrospective analysis.The changes of hemodynamic parameters(rhythm of the heart,systolic pressure,diastolic pressure,mean blood pressure,N-terminal pro-brain natriuretic peptide,oxygen saturation in peripheral blood)and cardiac function classification of New York Heart Association at four time points before admission(T1),administration and oral administration of ivabradine(T2),24 hours after oral administration of ivabradine(T3)and at discharge(T4)were analyzed.And the correlation between changes of rhythm of the heart and N-terminal pro-brain natriuretic peptide was analyzed.Results The average time of administration was 14.59±6.31 days.After treatment,the heart rate decreased in T3 and T4.Systolic blood pressure decreased at T3(P<0.05),and recovered to the early stage of treatment at T4.There was no significant difference in diastolic pressure,mean blood pressure and oxygen saturation(P>0.05).At the time of discharge,the New York Heart Association cardiac function grade increased(P<0.05).The level of N-terminal pro-brain natriuretic peptide is related to the heart rate at T2,and the total decrease level is related to the heart rate before and after administration.Conclusion It is effective and safe to treat acute decompensated systolic heart failure by ivabradine.