伊伐布雷定联合β受体阻滞剂在治疗ST段抬高型心肌梗死患者中的疗效

Effect of ivabradine combined withβ-blockers in patients with acute ST-segment elevation myocardial infarction

目的探讨伊伐布雷定联合β受体阻滞剂治疗ST段抬高型心肌梗死(STEMI)患者的临床效果。方法选择2016年7月至2019年7月期间丹东市第一医院接收的78例STEMI患者,随机分为观察组和对照组,在经皮冠状动脉介入治疗(PCI)术后予以不同治疗方式,观察组予以伊伐布雷定联合美托洛尔进行治疗,对照组单纯予以美托洛尔进行治疗,比较两组患者的超声心动图、心脏磁共振(CMR)图像、心率、心肌损伤标志物、运动耐量试验(ETT)检测结果以及治疗期间的心血管主要不良事件(MACE)的发生率。结果观察组术后60 d的左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)水平显著低于对照组(t=-2.203、7.431,P<0.05),左心室射血分数(LVEF)水平显著高于对照组(t=2.054,P<0.05)。PCI术后60 d观察组患者的微血管阻塞(MVO)、心肌内出血(IMH)和心肌梗死面积(IS)指标水平显著低于对照组(t=-7.039、-9.154、-4.964,P<0.05)。术后两组患者的心率下降,观察组患者术后1 d的心率下降程度显著高于对照组(t=-4.073,P<0.05);术后30 d和60 d时,观察组患者的N末端B型钠尿肽前体(NT-pro BNP)水平显著低于对照组(t=-2.444、-13.350,P<0.05)。术后30 d和60 d观察组患者的总运动时间显著长于对照组(t=9.026、5.191,P<0.05),心率和收缩压乘积(RPP)也显著低于对照组(t=4.223、3.409,P<0.05)。两组患者的MACE发生率没有显著差异(χ^(2)=0.214,P>0.05)。结论伊伐布雷定联合β受体阻滞剂能够改善行PCI的STEMI患者的左心室收缩功能和心肌功能,减少患者的IMH、IS和MVO,缓解患者心肌损伤,改善患者的运动能力。

Objective To explore the clinical effect of ivabradine combined withβ-blockers in patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 78 STEMI patients admitted into Dandong First Hospital from July 2016 to July 2019 were selected and randomly divided into observation group and control group.Different treatment methods were given after percutaneous coronary intervention(PCI).The observation group was treated with ivabradine combined with metoprolol,and the control group was treated with metoprolol alone.Echocardiography,cardiac magnetic resonance(CMR)images,heart rate,myocardial injury markers,physical and exercise tolerance test(ETT)results and the incidence of major cardiovascular adverse events(MACE)during treatment were compared between the two groups.Results The left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)in the observation group 60 days after operation were significantly lower than those in the control group(t=-2.203,-7.431;P<0.05),the left ventricular ejection fraction(LVEF)in the observation group 60 days after operation was significantly higher than that in the control group(t=2.054,P<0.05).Microvascular obstruction(MVO),intramyocardial hemorrhage(IMH)and myocardial infarction area(IS)in the observation group 60 days after PCI were significantly lower than those in the control group(t=-7.039,-9.154,-4.964;P<0.05).The heart rate in the two groups decreased after the operation,the decrease in the observation group 1 day after operation was significantly higher than that in the control group 1 day after operation(t=-4.073,P<0.05);and the levels of N-terminal B-type natriuretic peptide precursor(NT-pro BNP)in the observation group 30 d and 60 d after operation were significantly lower than those of the control group(t=-2.444,-13.350;P<0.05).The total exercise times of patients in the observation group 30 d and 60 d after PCI were significantly longer than those in the control group(t=9.026,5.191;P<0.05).The heart rate and systolic pressure product(RPP)in the observation group were also significantly lower than those in the control group(t=4.223,3.409;P<0.05).There was no significant difference in the incidence of MACE between the two groups(χ^(2)=0.214,P>0.05).Conclusion Ivabradine combined withβ-blockers can improve left ventricular systolic function and myocardial function in STEMI patients undergoing PCI,reduce their IMH,IS and MVO,alleviate myocardial damage,and improve their exercise capacity.