培哚普利对冠心病合并轻度充血性心力衰竭患者心率变异性和心功能的影响  

Effect of perindopril on heart rate variability and cardiac function in patients with coronary heart disease complicated by mild congestive heart failure

作　　者：刘品明[1] 许兆忠[1] 韩碧银[1] 吕俊豪[1] 傅向阳[1] 

机构地区：[1]第一军医大学珠江医院心内科,广东广州510282

出　　处：《第一军医大学学报》2000年第5期438-440,共3页Journal of First Military Medical University

摘　　要：目的 探讨血管紧张素转换酶抑制剂（ACEI）培哚普利对充血性心力衰竭（CHF）患者心脏自主神经活动的影响及其与心功能的关系。方法 对30例冠心病合并轻度CHF患者，采用单盲、随机、安慰剂平行对照法进行分组，并前瞻性观察经培哚普利治疗8、16 周后，其心率变异性（HRV）和心功能的变化。结果 经培哚普利治疗8 周时，与对照组比较，左心室收缩功能无显著变化，而HRV已有显著升高，尤以反映迷走神经张力的指标为著，如rMSSD从（30±17）ms升高至（35±13） ms（P＜0.01）、pNN50从（8±5）%提高至（11±6）%（P＜0.01）、HF从（9±2）ms升高至（14±3）ms（P＜0.01）；而反映交感神经与迷走神经活动均衡性的指标LH/HF从1.5±0.2下降至1.2±0.4 (P＜0.05) 。培哚普利治疗16 周时，随着左心室收缩功能的改善，HRV进一步升高。结论 研究表明，ACEI可提高CHF患者心脏迷走神经张力，降低交感神经张力，其早期效应不依赖于心功能的改善，提示应用ACEI治疗CHF，有可能减少心律失常性死亡。：Objective To assess the effects of angiotensin-converting enzyme inhibitors (ACEI) on cardiac autonomic nervous control and its impact on cardiac function in patients with congestive heart failure (CHF). Method Thirty patients with mild CHF coronary artery disease complicated by congestive heart failure were prospectively investigated in a randomized single-blind, paralleled manner. Perindopril (4 mg once daily) or placebo treatment was prescribed. At baseline and after 8, 16 weeks of treatment respectively, the parameters of heart rate variability (HRV) were recorded and the left ventricular systolic function assessed. Result After 8 weeks of therapy with perindopril, there was no significant changes in the parameters of left ventricular systolic function, compared with the placebo treatment group. In contrast, HRV parameters and in particular those of vagal tone, were improved, e.g. rMSSD was increased from (30±17) ms to (35±13) ms (P＜0.01), pNN50 was increased from (8±5)% to (11±6)% (P＜0.01), and HF was increased from (9±2) ms to (14±3) ms (P＜0.01); whereas, LH/HF, which indicates autonomic imbalance between sympathetic tone and vagal tone, was decreased from 1.5±0.2 to 1.2±0.4 (P＜0.01). After 16 weeks of therapy with perindopril, HRV parameters were further improved acommpanied by the improvements in cardiac function. Conclusion These results demonstrate that the treatment with ACEI increases cardiac vagal activity and decreases sympathetic activity in patients with CHF, and the effect may not depend on the improvements in cardiac function. It also suggests that ACEI may reduce the arrhythmic mortality of CHF.

关 键 词：充血性心力衰竭 心率变异性 培哚普利 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病] R541.61[医药卫生—内科学]