伊伐布雷定在脓毒症合并急性心力衰竭易损期患者中应用1年随访疗效分析

One-year follow-up of ivabradine in the patients with sepsis complicated with acute heart failure in the vulnerable period

目的探讨伊伐布雷定在脓毒症合并急性心力衰竭易损期患者中应用的疗效与安全性。方法纳入脓毒症合并急性心力衰竭患者共140例,按不同治疗方式分为伊伐布雷定组(n=73)和对照组(n=67)。比较两组患者一般资料,治疗前后平均动脉压、心率、NT-pro BNP、院内死亡、再发急性心力衰竭及12个月全因死亡和心力衰竭再入院发生率。随访计量资料采取一般线性模型重复测量的方差分析,Kaplan-Meier法绘制生存曲线。结果伊伐布雷定组住ICU时间(d:6.99±3.04 vs.8.75±3.13,P=0.001)和住院时间(d:9.08±3.67 vs.11.09±3.79,P=0.002)明显低于对照组。两组患者院内病死率(11.0%vs.13.4%)和12个月全因病死率(19.2%vs.23.9%)差异无统计学意义。伊伐布雷定组12个月心力衰竭再入院率明显低于对照组(11.0%vs.23.9%,P=0.043)。重复测量的方差分析显示,两组患者心率、NT-pro BNP均随时间明显降低(P<0.001)。简单效应分析显示,心率、NT-pro BNP与时间和使用伊伐布雷定存在明显交互效应(P<0.001)。KM曲线显示,伊伐布雷定组12个月心力衰竭再入院率明显低于对照组(P=0.046)。结论脓毒症合并急性心力衰竭患者易损期应用伊伐布雷定可以明显降低患者心率、NT-pro BNP及12个月心力衰竭再入院率。

Objective To investigate the safety and efficacy of ivabradine in the patients with sepsis complicated with acute heart failure in the vulnerable period. Methods A total of 140 patients with sepsis complicated with acute heart failure were enrolled and divided into ivabradine group( 73 cases) and control group( 67 cases) according to different treatment methods. The general information,mean arterial pressure,heart rate,NT-pro BNP,in-hospital death and recurrent acute heart failure,12-month all-cause death and readmission of heart failure were compared between the two groups. The measurement data of follow-up were analyzed by ANOVA of repeated measurement with general linear model. Kaplan-Meier method was used to draw survival curve. Results ICU time and hospital stay in ivabradine group were significantly lower than those in control group( d: 6. 99 ± 3. 04 vs. 8. 75 ± 3. 13,P = 0. 001;d: 9. 08 ± 3. 67 vs. 11. 09 ± 3. 79,P = 0. 002). There was no significant difference in hospital mortality and 12-month all-cause mortality between the two groups( 11. 0% vs. 13. 4%;19. 2%vs. 23. 9%). The 12-month readmission rate of heart failure in ivabradine group was significantly lower than that in control group( 11. 0% vs. 23. 9%,P = 0. 043). ANOVA of repeated measurement showed that heart rate and NT-pro BNP decreased significantly with time in both groups( P < 0. 001).Simple effect analysis showed that heart rate and NT-pro BNP had significant interaction with the time and the use of ivabradine( P < 0. 001). KM curve showed that the readmission rate of heart failure in the ivabradine group at 12 months was significantly lower than that in the control group( P = 0. 046).Conclusions In the patients with sepsis complicated with acute heart failure in the vulnerable period,ivabradine can significantly reduce heart rate,NT-pro BNP and 12-month readmission rate of heart failure.