伊伐布雷定治疗中重度慢性心力衰竭伴窦性心动过速的临床研究

黄琨; 马威; 郑川燕; 张静怡; 穆怀彬; 李斯; 张宇; 孙淑娴; 吴峥; 张春来

doi:10.13201/j.issn.1001-1439.2017.09.007

伊伐布雷定治疗中重度慢性心力衰竭伴窦性心动过速的临床研究

- 1 唐山工人医院心内科(河北唐山, 063000);
- 2 首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心内科
基金项目:
国家自然科学基金 (No:81070227)

北京市自然科学基金 (No:7142048)

唐山市科技指令科学技术研究与发展项目 (No:12150222B-15)

详细信息

通讯作者: 张春来, E-mail:huangkun_hk@sina.com

中图分类号: R541.6

收稿日期: 2017-03-27

Clinical study of ivabradine in the treatment of moderate and severe chronic heart failure complicated with sinus tachycardia

- 1 Department of Cardiology, Tangshan worker Hospital, Tangshan, 063000, China;
- 2 Department of Cardiology, Beijing AnZhen Hospital affiliated to Capital Medical University, Beijing Institute of cardio pulmonary vascular diseases

More Information

Corresponding author: ZHANG Chunlai, E-mail: huangkun_hk@sina.com

Received Date: 27 March 2017

摘要

摘要: 目的:观察并探讨伊伐布雷定(IVB)治疗Ⅲ~Ⅳ级老年慢性心力衰竭(CHF)伴窦性心动过速的临床疗效与安全性。方法:将2015-07-2016-10收治的95例患者按照随机数字表分为观察组(42例)和对照组(44例),在常规抗心力衰竭(心衰)的治疗基础上,对照组加服富马酸比索洛尔,观察组加服盐酸IVB,疗程2个月,治疗前后测定超声心动图参数[左心室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD、左室射血分数(LVEF)]、血清生物标志物[B型脑钠肽(BNP)、半乳糖凝集素-3(Gal-3)]、心率(HR)及6 min步行距离(6MWD),记录治疗期间药物相关不良反应。结果:治疗后,2组超声心动图参数、生物标志物水平、HR、6MWD均较治疗前改善。2组治疗后LVEDD、LVESD、LVEF差异均无统计学意义(P>0.05);观察组治疗后BNP、Gal-3下降数值均显著高于对照组[(482.6±53.5) pg/ml∶(457.6±48.7) pg/ml、(13.9±4.1) ng/ml∶(12.5±3.6) ng/ml](P<0.05);观察组治疗后HR下降数值[(56.6±4.9)次/min∶(54.4±4.2)次/min]与6MWD提高数值[(212.8±41.5) m∶(193.7±35.2) m]均显著高于对照组(P<0.05);对照组4例比索洛尔达最大推荐剂量但HR仍未达标者,改服IVB后达到目标HR;观察组光幻视发生率23.8%,对照组低血压或心动过缓发生率11.4%,组间差异均有统计学意义(P<0.05),其余不良反应无显著性差异(P>0.05)。结论:IVB较β受体阻滞剂治疗中重度心衰伴窦性心动过速短期内在减缓HR、提高运动耐力及临床安全性方面具有比较优势,为β受体阻滞剂反应性不佳患者提供了另一种选择。
- 伊伐布雷定 /
- 心力衰竭 /
- 窦性心动过速 /
- 心率 /
- 6min步行距离 /
- 生物标记物
Abstract: Objective:To observe and explore the efficacy and safety of ivabradine (IVB) in the treatment of heart function of grade Ⅲ~Ⅳ elderly chronic heart failure patients with sinus tachycardia.Method:Ninety-five patients in July 2015 to October 2016 were randomly divided into observation group (42 cases) and control group (44 cases), based on routine anti heart failure treatment.Control and observation group were given bisoprolol and IVB hydrochloride respectively for 2 months.Ultrasound echocardiography parameters (LVEDD, LVESD, LVEF), serum biomarkers (BNP, Gal-3), heart rate (HR), 1 min heart rate (HR) and 6min walking distance (6MWD) before and after the treatment were examined, and drug related adverse reactions during the treatment were record.Result:After treatment, echocardiography parameters, biomarker levels, 1 minHR, 6 MWD of two groups were significantly improved compared with those before treatment (P<0.05).The two groups after treatment showed no significant differences on LVEDD, LVESD and LVEF (P> 0.05).The decreased value of BNP and Gal-3 in observation group after treatment were significantly lower than those in the control group[(482.6±53.5) pg/ml vs (457.6±48.7) pg/ml, (13.9±4.1) ng/ml vs (12.5±3.6) ng/ml] (P<0.05);the observation group after treatment with The decreased value of HR[(56.6±4.9) bpm vs (54.4±4.2) bpm]and increased value of 6MWD[(212.8±41.5) min vs (193.7±35.2) min]observation group were both significantly higher than the control group (P<0.05), whereas was significantly higher than the control group (398.3±56.8) m vs (372.6±59.0) m (P<0.05);4 cases in control group with the maximum recommended dose bisoprolol but not yet achieved target HR had taken IVB reached the target HR;the observation group with phosphene incidence was 23.8%, control group of hypotension or bradycardia was 11.4%, differences between groups were statistically significant (P<0.05), there were no significant differences on other adverse reactions (P>0.05). Conclusion:Compared with β blocker, IVB in treatment of moderate and severe heart failure complicated with sinus tachycardia showing comparative advantages in slowing HR, improving exercise tolerance and clinical safety, which provides another choice for patients with poor responsive to β blocker.
- ivabradine /
- heart failure /
- sinus tachycardia /
- heart rate /
- 6min walking distance /
- biological markers

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