美托洛尔联合伊伐布雷定对重度心力衰竭合并窦性心动过速患者心功能的影响

Effects of metoprolol combined with ivabradine on cardiac function in patients with severe heart failure complicated with sinus tachycardia

目的探讨美托洛尔联合伊伐布雷定对重度心力衰竭合并窦性心动过速患者心功能的影响。方法选择2017年11月至2019年1月在扬中市人民医院接受治疗的86例重度慢性心力衰竭合并窦性心动过速的患者为研究对象。采用随机数字表法分为对照组和观察组各43例。两组患者入院后均给予休息、吸氧等处理,然后根据病情使用血管紧张素转化酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARBs)、正性肌力药、利尿剂等进行常规抗心力衰竭治疗。在此基础上,对照组患者加用美托洛尔,观察组患者加用美托洛尔联合伊伐布雷定治疗。比较两组患者临床疗效、心功能指标、静息心率、运动最大心率及不良反应的差异。结果观察组总有效率明显高于对照组(86.0%、67.4%;χ^2=4.170,P <0.05)。治疗后观察组的氨基末端脑钠肽前体(NT-proBNP)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)均显著优于对照组(t=3.475、2.056、2.174,P <0.05),观察组的左心室射血分数(LVEF)、6分钟步行距离(6-MWT)均显著优于对照组(t=3.012、3.974,P <0.05),观察组静息心率、最大心率显著优于对照组(t=3.011、2.584,P <0.05)。两组不良反应比较差异无统计学意义(χ^2=0.584,P> 0.05)。结论美托洛尔联合伊伐布雷定治疗重度心力衰竭合并窦性心动过速的疗效确切,能改善患者心功能,减缓心率,提高运动耐力。

Objective To investigate the effect of metoprolol combined with ivabradine on cardiac function in patients with severe heart failure complicated with sinus tachycardia.Methods 86 patients with severe heart failure complicated with sinus tachycardia who were treated in Yangzhong people’s hospital from November 2017 to January 2019 were selected as the research objects.The patients were randomly divided into control group and observation group with 43 cases in each group by random number table method.Both groups of patients were given rest and oxygen inhalation after admission.Then angiotensin-converting enzyme inhibitors(ACEI),AngiotensinⅡreceptor antagonist(ARBs),cardiac tonic and diuretic are used for routine anti-heart failure treatment according to the disease condition.On this basis,patients in the control group were treated with metoprolol,while patients in the observation group were treated with metoprolol combined with Ivabradine.The clinical efficacy,cardiac function index,resting heart rate,exercise maximum heart rate and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was 86.0%(37/43),which was significantly higher than that of the control group 67.4%(29/43),(χ2=4.170,P<0.05).After treatment,amino-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end diastolic dimension(LVEDD)and left ventricular end-systolic dimension(LVESD)in the observation group was better than those in the control group(t=3.475,2.056,2.174,P<0.05),left ventricular ejection fraction(LVEF)and six minute walk distance(6-MWT)of the observation group was superior to the control group(t=3.012,3.974,P<0.05).After treatment,resting heart rate and the exercise maximum heart rate of the observation group was superior to the control group(t=3.011,2.584,P<0.05).There was no significant difference in adverse reactions between the two groups(χ2=0.584,P<0.05).Conclusion Metoprolol combined with Ivabradine has definite curative effect on severe heart failure complicated with sinus tachycardia,which can obviously improve the patients’cardiac function,slow down heart rate and increase exercise endurance.