伊伐布雷定治疗慢性阻塞性肺疾病合并心力衰竭的临床效果及安全性

Clinical efficacy and safety of Ivabradine in the treatment of chronic obstructive pulmonary disease complicated with heart failure

目的探讨伊伐布雷定治疗慢性阻塞性肺疾病(COPD)合并心力衰竭的临床效果及安全性。方法选取2018年1月至2021年1月茂名市人民医院收治的80例COPD合并心力衰竭患者作为研究对象,按随机数字表法分为对照组与观察组,各40例。对照组予以常规抗心力衰竭治疗,观察组在对照组的基础上加用伊伐布雷定治疗。两组均持续用药3个月。比较两组的心功能[左室射血分数(LVEF)、心排血量(CO)及每搏输出量(SV)]、静息心率变化、N末端脑钠肽前体(NT-proBNP)水平、6 min步行距离及肺功能[呼气峰流速(PEF)、用力肺活量(FVC)及第1秒用力呼气容积(FEV1)],并记录两组的不良反应发生情况。结果两组患者治疗后的LVEF、CO、SV水平高于治疗前,差异有统计学意义(P<0.05);观察组治疗后的LVEF、CO、SV水平高于对照组,差异有统计学意义(P<0.05);两组患者治疗前的静息心率变化、NT-proBNP水平及6 min步行距离比较,差异无统计学意义(P>0.05);两组患者治疗后的静息心率、NT-proBNP水平低于治疗前,6 min步行距离长于治疗前,差异有统计学意义(P<0.05);观察组治疗后的静息心率、NT-proBNP水平低于对照组,6 min步行距离长于对照组,差异有统计学意义(P<0.05);两组患者治疗前的PEF、FVC、FEV1水平比较,差异无统计学意义(P>0.05);两组患者治疗后的PEF、FVC、FEV1水平均高于治疗前,差异有统计学意义(P<0.05);观察组治疗后的PEF、FVC、FEV1水平高于对照组,差异有统计学意义(P<0.05);两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论伊伐布雷定可增强COPD合并心力衰竭的治疗效果,纠正心肺功能异常,降低NT-proBNP水平,稳定静息心率,安全可靠。

Objective To investigate the clinical effect and safety of Ivabradine in the treatment of chronic obstructive pulmonary disease(COPD)complicated with heart failure.Methods A total of 80 patients with COPD and heart failure who were admitted to Maoming People′s Hospital from January 2018 to January 2021 were selected as research objects,and they were divided into the control group and the observation group according to the random number table method,with 40 cases in each group.The control group was given conventional anti-heart failure treatment,and the observation group was additionally given Ivabradine on the basis of the control group.The two groups were treated for 3 months.The cardiac function(left ventricular ejection fraction[LVEF],cardiac output[CO]and stroke volume[SV]),resting heart rate changes,and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels,6 min walking distance and pulmonary function(peak expiratory flow rate[PEF],forced vital capacity[FVC]and forced expiratory volume in 1 second[FEV1])were compared between the two groups,and the occurrence of adverse reactions were record between the two groups.Results There were no significant differences in the levels of LVEF,CO and SV between the two groups before treatment(P>0.05).The levels of LVEF,CO and SV in the two groups after treatment were higher than those before treatment,and the differences were statistically significant(P<0.05).The levels of LVEF,CO and SV in the observation group after treatment were higher than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the resting heart rate,the level of NT-proBNP and 6-min walking distance between the two groups before treatment (P>0.05). The resting heart rate and the level of NT-proBNP in the two groups after treatment were lower than those before treatment, and the 6-min walking distance in the two groups after treatment was longer than that before treatment, the differences were statistically significant (P<0.05). The resting heart rate and the level of NT-proBNP in the observation group after treatment were lower than those in the control group, the 6-min walking distance in the observation group after treatment was longer than that in the control group, and the differences were statistically significant (P<0.05). There were no significant difference in the levels of PEF, FVC, FEV1 between the two groups before treatment (P>0.05). The levels of PEF, FVC in the two groups after treatment were higher than those before treatment, the differences were statistically significant (P<0.05). The levels of PEF, FVC, FEV1 in the observation group after treatment were higher than those in the control group after treatment, the differences were statistically significant (P<0.05). There was no significant difference in the total incidence of adverse reactions in the two groups (P>0.05). Conclusion Ivabradine can enhance the therapeutic effect of COPD complicated with heart failure, correct the abnormal cardiopulmonary function, reduce the level of NT-proBNP, and stabilize the resting heart rate, which is safe and reliable.