伊伐布雷定对急性失代偿性左心室射血分数降低型心力衰竭患者的近期疗效

Short-term efficacy of ivabradine in patients with acute decompensated heart failure with reduced ejection fraction

目的对急性失代偿性射血分数降低型心力衰竭(ADHFrEF)患者在常规药物治疗基础上加用伊伐布雷定,观察伊伐布雷定的临床疗效及安全性。方法50例ADHFrEF患者随机分入对照组和观察组。对照组给予基础抗心衰治疗,观察组在对照组治疗基础上,加用伊伐布雷定5 mg,每日两次,口服,根据心率反应调整剂量。比较两组治疗前后患者心率、血压、心功能指标、血浆生化指标、平均住院时间以及主要不良心血管事件和不良反应。结果两组患者治疗后,平均心率(HR)、BNP水平均较治疗前显著下降,6分钟步行距离(6MD)和左心室射血分数(LVEF)较治疗前显著提高(均P<0.05),左心室舒张末内径(LVEDD)和心室收缩末内径(LVESD)较治疗前缩小(均P<0.05)。与对照组比较,伊伐布雷定可进一步减慢心率,提高6MD和LVEF(均P<0.05)。结论在基础抗心衰治疗基础上加用伊伐布雷定能进一步改善ADHFrEF患者心脏功能、提高患者运动耐量。

Objective To observe the clinical efficacy and safety of ivabradine in patients with acute decompensated heart failure with reduced ejection fraction(ADHFrEF)on the basis of conventional drug therapy.Methods Fifty patients with ADHFrEF were randomly devided in to control group(group C)and observation group(group O).Group C was given routine anti-heart failure treatment.Group O was treated with ivabradine 5 mg orally in addition to the routine anti heart failure treatment.Ivabradine dose was adjusted according to the heart rate response.The heart rate(HR),blood pressure,cardiac function indexes,plasma biochemical parameters,average hospital stay,major adverse cardiovascular events and side effects of these two groups were compared before and after treatment.Results After treatment,the average HR and brain natriuretic peptide(BNP)lvevel in two groups were significantly lower than those before treatment.The 6-minute walking distance(6MD)and left ventricular ejection fraction(LVEF)were significantly higher than those before treatment(both P<0.05).The left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)were smaller than those before treatment(both P<0.05).Compared to group C,ivabradine could further slow HR,and increase 6MD and LVEF(all P<0.05).Conclusion On the basic of routine anti-heart failure treatment ivabradine can further improve the cardiac function and improve the exercise tolerance of patients with ADHFrEF.