伊伐布雷定对冠脉CTA检查患者心率控制的临床研究

Clinical study of ivabradine for heart rate control during coronary computed tomography angiography

目的探讨冠脉CTA检查前口服伊伐布雷定的安全性与有效性。方法选择2020年4月~2021年3月在江门市新会区人民医院行冠脉CTA检查的患者共210例,随机分为三组:A组和B组患者分别在检查前1 h口服伊伐布雷定5 mg(A组,n=70)或7.5 mg(B组,n=70),C组患者在检查前1 h口服美托洛尔50 mg(n=70)。观察各组患者入院(门诊)就诊时(T0)、入室扫描前(T1)、扫描期间(T2)的心率、血压与心率达标率(T2<70次/分),单次检查成功率、不良反应(如心功能不全及严重心律失常)等,并评估分节段冠脉图像质量。结果三组患者研究基线齐同可比,T0时心率分别为(77.5±14.6)、(75.4±17.9)、(76.2±20.3)次/分,T1时B组患者心率较T0下降(14.6±4.1)次/分,较A组(12.2±4.7)次/分及C组(10.1±5.6)次/分明显降低,差异均具有统计学意义(P<0.001);三组患者T2时心率达标率分别为78.6%、91.4%、82.9%,一次检查成功率分别91.4%、95.7%、88.6%,B组均优于A、C两组,但组间差异无统计学意义(P=0.1038、P=0.2964);分析冠脉节段图像质量,三组0级图像分别有8、4、18个节段,B组图像分级较高、质量较好,组间差异具有统计学意义(P=0.015);T1收缩压下降(5.3±3.6)、(6.5±3.9)、(13.8±7.7)mmHg,舒张压下降(4.5±2.1)、(4.9±3.7)、(7.8±5.6)mmHg,C组血压差较大,差异均具有统计学意义(P<0.001)。三组患者均无报告或记录不良反应。结论行冠脉CTA检查前使用伊伐布雷定可以提高检查成功率,适宜在临床上尤其是没配备科学研究型CT设备的基层医院推广应用。

Objective To investigate the safety and efficacy of oral ivabradine tablets before coronary CTA(computed tomography angiography)examination.Methods A total of 210 patients who underwent coronary CTA in Jiangmen Xinhui District People's Hospital from January to December 2020 were randomly divided into three groups:group A and group B were given oral ivabradine 5 mg(group A,n=70)or 7.5 mg(group B,n=70)1 hour before the examination,and group C was given oral metoprolol 50 mg(n=70)1 hour before the examination.The heart rate,blood pressure and heart rate compliance rate(T_(2)<70 beats/min),success rate of single examination,adverse reactions(such as cardiac insufficiency and severe arrhythmia)of patients in each group were observed at admission(outpatient)visit(T_(0)),before in room scanning(T_(1))and during scanning(T_(2)),and the image quality of segmental coronary artery was evaluated.Results The baseline of the three groups was comparable.The heart rate at T_(0) was(77.5±14.6)、(75.4±17.9)、(76.2±20.3)beats/min respectively.Comparison of heart rate at T_(0),the decrease in heart rate of group B was(14.6±4.1)beats/min at T_(1),lower than(12.2±4.7)beats/min in group A and(10.1±5.6)beats/min in group C,and the differences were statistically significant(P<0.001).The rate of Heart rate up to test standard at T_(2) of the three groups was 78.6%,91.4%,82.9%,and the success rate of one-time examination was 91.4%,95.7%,88.6%,which was significantly higher than that in group B(P<0.001).Compared with group A and C,there was no significant difference in three groups(P=0.103,8,P=0.296,4).Analysis of the image quality of coronary segments showed that there were 8,4 and 18 segments in grade 0 images of the three groups,and there was significant difference in three groups(P=0.015);Systolic blood pressure at T_(1) decreased by(5.3±3.6),(6.5±3.9)and(13.8±7.7)mmHg,diastolic blood pressure decreased by(4.5±2.1),(4.9±3.7)and(7.8±5.6)mmHg.the difference of blood pressure in group C was significant(P<0.001).No adverse reactions were reported or recorded in the three groups.Conclusion The use of ivabradine before the application of 64 slice 128 row helical CT for coronary CTA can improve the success rate of the examination,and be suitable for clinical and especially basic hospital promotion without scientific research-based CT equipment.