伊伐布雷定对急性ST段抬高型心肌梗死合并射血分数保留型心力衰竭患者心率及心功能的影响

Effect of ivabradine on heart rate and heart function in patients with acute ST-segment elevation myocardial infarction combined with heart failure with preserved ejection fraction

目的探讨伊伐布雷定对急性ST段抬高型心肌梗死(STEMI)合并射血分数保留型心力衰竭(HFpEF)患者心率及心功能的影响。方法将64例急性STEMI合并HFpEF患者随机分为治疗组和对照组,各32例。两组患者均接受急诊经皮冠状动脉介入治疗、冠心病二级预防、抗心力衰竭等标准治疗,治疗组在此基础上口服伊伐布雷定。比较两组患者治疗前及治疗后1 d、5 d、7 d、60 d的静息心率、左心室舒张功能指标(舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度的比值、左心房容积指数)、N末端B型利钠肽前体水平、超声心动图指标(左心室射血分数、左心室舒张末期容积、左心室收缩末期容积、左心室舒张末期内径、每搏输出量),记录两组患者治疗期间不良反应的发生情况。结果治疗组患者治疗后各时间点的静息心率水平均低于对照组患者,治疗后60 d的左心室舒张功能指标、超声心动图指标均优于对照组患者(均P<0.05)。两组患者不良反应发生率的差异无统计学意义(P>0.05)。结论经皮冠状动脉介入治疗后应用伊伐布雷定可有效控制急性STEMI合并HFpEF患者的心率,改善其心功能,且安全性良好。

Objective To explore the effect of ivabradine on heart rate and heart function in patients with acute ST-segment elevation myocardial infarction(STEMI)combined with heart failure with preserved ejection fraction(HFpEF).Methods Sixty-four acute STEMI patients combined with HFpEF were randomly assigned to treatment group or control group,with 32 cases in each group.Both groups received standard therapy with respect to emergency percutaneous coronary intervention,secondary prevention of coronary heart disease,and anti-heart failure,etc.,based on which the treatment group received oral administration of ivabradine.Before treatment and at 1,5,7,and 60 days after treatment,the resting heart rate,left ventricular diastolic function indices in terms of early diastolic blood flow velocity in mitral valve to early diastolic motion velocity in mitral valve ring ratio,and left atrial volume index,and N-terminal pro-brain natriuretic peptide level,as well as echocardiographic indices with respect to left ventricular ejection fraction,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular end-diastolic diameter,and stroke volume were compared between the two groups.The occurrence of adverse reactions during treatment was recorded in both groups.Results The treatment group yielded a lower resting heart rate at various time points after treatment as compared with the control group,and superior indices of left ventricular diastolic function and echocardiography at 60 days after treatment as compared with the control group(all P<0.05).No statistically significant difference in the incidence rate of adverse reactions of patients was found between the two groups(P>0.05).Conclusion The application of ivabradine after percutaneous coronary intervention can effectively control heat rate of patients with acute STEMI combined with HFpEF,and ameliorate their heat function,exerting a favorable safety.