伊伐布雷定对慢性缺血性心力衰竭患者心功能及心率变异性的影响

The effect of ivalbramine on cardiac function and heart rate variability in patients with chronic ischemic heart failure

目的研究伊伐布雷定对慢性缺血性心力衰竭患者心功能及心率变异性的影响。方法148例慢性缺血性心力衰竭患者,随机分为对照组及观察组,各74例。对照组给予标准化抗心力衰竭治疗,观察组在对照组基础上加用伊伐布雷定治疗。比较两组患者治疗前后的心功能指标[心率(HR)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、6 min步行距离(6MWD)]及心率变异性指标[24 h窦性心律R-R间期标准差(SDNN)、24 h连续5 min正常R-R间期均值标准差(SDANN)、24 h相邻正常R-R间期差值均方根(RMSSD)、24 h相邻正常R-R间期差值>50 ms百分比(RNN50)]。结果治疗后,两组患者的HR、LVESD、LVEDD较本组治疗前降低,6MWD、LVEF较本组治疗前升高,且观察组患者的HR、LVESD、LVEDD低于对照组,6MWD、LVEF高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组患者的SDNN、SDANN、RMSSD、RNN50较本组治疗前升高,且观察组患者的SDNN(116.47±13.18)ms、SDANN(88.33±9.20)ms、RMSSD(49.78±7.61)ms、RNN50(11.93±4.18)%均高于对照组的(98.14±12.10)ms、(74.16±7.40)ms、(41.30±6.23)ms、(9.76±3.81)%,差异具有统计学意义(P<0.05)。结论伊伐布雷定可明显改善慢性缺血性心力衰竭患者的心功能和心率变异性,提高其运动耐量。

Objective To study the effect of ivalbramine on cardiac function and heart rate variability in patients with chronic ischemic heart failure.Methods A total of 148 patients with chronic ischemic heart failure were randomly divided into a control group and an observation group,with 74 cases in each group.The control group was treated with standardized anti-heart failure therapy,and the observation group was treated with ivabradine on the basis of the control group.The cardiac function indexes[heart rate(HR),left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),6-min walking distance(6MWD)],and heart rate variability indexes[standard deviation of R-R intervals(SDNN),standard deviation of mean normal R-R intervals for 5 min segments(SDANN),root mean square successive difference(RMSSD),differences between adjacent normal R-R intervals>50 ms(RNN50)]before and after treatment were compared between the two groups.Results After treatment,the HR,LVESD,and LVEDD of the two groups were lower than those of the groups before treatment,and 6MWD and LVEF were higher than those of the groups before treatment;the HR,LVESD,and LVEDD of the observation group were lower than those of the control group,and 6MWD and LVEF were higher than those of the control group;all the difference was statistically significant(P<0.05).After treatment,the SDNN,SDANN,RMSSD,and RNN50 of the two groups were higher than those of the groups before treatment,and the SDNN(116.47±13.18)ms,SDANN(88.33±9.20)ms,RMSSD(49.78±7.61)ms,RNN50(11.93±4.18)%of the observation group were higher than(98.14±12.10)ms,(74.16±7.40)ms,(41.30±6.23)ms,(9.76±3.81)%of the control group.All the difference was statistically significant(P<0.05).Conclusion Ivalbramine can obviously improve cardiac function and heart rate variability,improve exercise tolerance of patient with chronic ischemic heart failure.