伊伐布雷定治疗射血分数降低性心力衰竭伴窦性心律患者的临床观察

Clinical efficacy of Ivabradine in the treatment of heart failure with reduced ejection fraction with sinus rhythm

目的:观察伊伐布雷定治疗射血分数降低性心力衰竭(HFrEF)的临床疗效及对左心室功能、生命质量的影响。方法:选取北京安贞医院心内科住院及门诊就诊的112例,LVEF≤40%的心力衰竭患者,分为IVB组(53例)和对照组(59例),根据心力衰竭指南给予两组患者标准化治疗;观察组在此基础上,因存在β受体阻滞剂使用剂量受限,或者β受体阻滞剂已达到最大靶剂量,窦性心律仍≥70次/min的情况,加用伊伐布雷定治疗起始剂量为2.5mg/次,2次/d,最大使用剂量为7.5mg/次,2次/d,心率控制在60次/min左右。连续用药治疗3个月。观察两组治疗前后心率、NT-proBNP、LVEF、LVESD、LVEDD、6min步行距离(6MWD)、明尼苏达心功能不全生命质量量表(MLHFQ)变化及两组发生的不良反应。结果:治疗3个月后,两组患者心率均有所降低,IVB组下降明显优于对照组[(65.42±5.15)vs.(74.69±6.38)次/min,P<0.01]。两组NT-proBNP水平均有明显降低,且IVB组降低更加显著[(402.60±185.93)vs.(708.99±221.07)ng/L,P<0.01]。两组心脏重构指标(LVEF、LVEDD),IVB组改善更显著(P<0.01)。LVEF升高[(50.2±5.8)%vs.(41.6±5.3)%];LVEDD缩小[(52.6±6.3)vs.(59.5±6.8)mm,P<0.01]。两组患者6MWD均有增加,IVB组增加更加显著,[(391.67±23.59)vs.(317.40±2567)mm,P<0.01]。MLHFQ评分均降低,IVB组降低更加明显,[(37.6±8.2)vs.(49.1±8.6),P<0.01]。两组用药期间不良反应较少,主要的不良反应为心动过缓,予以调整药物剂量后心动过缓可以纠正,且两组差异无统计学意义(P>0.05)。结论:在标准化心力衰竭治疗的基础上加用伊伐布雷定,可更加有效降低HFrEF患者的心率、NT-proBNP水平、改善心功能、提高生命质量,且安全性良好,是治疗HFrEF安全有效的药物。

Objective:To observe the clinicaleffect of Ivabradinein heart failure with reduce dejection fraction(EFr HF)with sinus rhythmon cardiac function and quality of life.Methods:Totally,112 heart failure patients with LVEF≤40%and sinus rhythmwere selected from our Hospital.All patients were given traditional treatment baseon the heart failure guide lines recommendations.Patients were divided into two groups based on whether Ivabradine was used.Becausethedosage ofβreceptor blockers is limited by different conditions orevenβReceptor blocker reached the maximum target dose,sinus rhythmcannot be less than 70bpm,So,53 cases whose sinus rhythmwithheartrate(HR)still≥70bpm,then,Ivabradine weregiven on the basis of the control group(IVB group).Theinitil doseof Ivabradine was 2.5mg/time twice a day,the maximum of 7.5mg/time twice a day.There sting hear trate was minute aimed at about 60 bpm.sinus rhythm,NT-proBNP,cardiac function,6 minutes walk test(6MWT),MLHFQ and adverse reactions before and after treatment were compared between the two groups.Results:After treatment for 3 months,sinus rhythm in the IVB group was significantly decreased than the control group,[(65.42±5.15)vs.(74.69±6.38)bpm,P<0.01].NT-pro BNP in all patients were decreased after treatment,and the IVB group were significantly lower than the control group[(402.60±185.93)vs.(708.99±221.07)ng/L,P<0.01].Compared with the control group,LVEF[(50.2±5.8)%vs.(41.6±5.3)%,P<0.01]and LVEDD[(52.6±6.3)vs.(59.5±6.8)mm,P<0.05]were improved significant in IVB group.After treatment,compared with 6MWD,IVB group increased significantly,[(391.67±23.59)vs.(317.4±25.67)mm,P<0.01].MLHFQ were all decreased in both groups,and the IVB group improved better than the control group,MLHFQ[(37.6±8.2)vs.(49.1.5±8.6),P<0.01].There was few drug adverse reactions recorded,The main adverse reaction was bradycardia,andthere was no significant difference be tween the two groups.Conclusions:Ivabradinecombined with guideline-directed treatment can significantly reduce sinus rhythm,NT-proBNP,MLHFQ,improve exercise tolerance,and significantly improve heart function on the EFrHF patients,and with better safety.