心脏再同步治疗反应性与β受体阻滞剂及血管紧张素转化酶抑制剂的关系  

Relationship between response to cardiac resynchronization therapy and beta-blocker and angiotensin-converting enzyme inhibitor

作　　者：高运来[1] 张常莹[1] 陆娟[1] 戴敏[1] 李库林[1] 郑杰[1] 郁志明[1] 王如兴[1] 

机构地区：[1]南京医科大学附属无锡市人民医院心内科,江苏无锡214023

出　　处：《临床荟萃》2015年第6期605-608,612,共5页Clinical Focus

摘　　要：目的分析心脏再同步治疗(CRT)患者术后药物治疗情况及与CRT反应性的关系。方法行CRT的慢性心力衰竭患者35例,平均年龄(64.1±9.7)岁;所有患者术前及术后6个月均行常规超声心动图检查,并根据临床表现评估术前及术后6个月患者心功能分级。对患者CRT植入前后药物治疗情况,尤其是β受体阻滞剂及血管紧张素转化酶抑制剂(ACEI)的使用情况进行分析。根据CRT术后反应性分为有反应组及无反应组,对两组β受体阻滞剂及ACEI术前和术后使用情况进行比较,分析CRT反应性与药物剂量变化的关系。结果 CRT临床有反应组28例,无反应组7例。有反应组术前和术后美托洛尔平均使用剂量分别为(25.0±11.0)mg/d和(59.6±24.4)mg/d(P<0.01),而无反应组术前和术后美托洛尔平均使用剂量分别为(25.0±8.8)mg/d和(27.5±22.4)mg/d(P>0.05)。CRT治疗有反应组术前和术后培哚普利日平均使用剂量分别为(3.47±0.91)mg/d和(4.74±1.52)mg/d(P<0.05),而无反应组术前和术后培哚普利日平均使用剂量分别为(3.60±0.89)mg/d和(3.80±0.45)mg/d(P>0.05)。CRT术后反应性与CRT治疗前后β受体阻滞剂剂量变化有较好的相关性(r=0.688,P<0.01),而与ACEI剂量变化无明显相关性(r=0.355,P>0.05)。结论 CRT反应性与术后优化药物治疗相关,其治疗效果是优化药物治疗及起搏器治疗的共同作用结果。Objective To investigate pharmacologic therapy in patients receiving cardiac resynchronization therapy （CRT）and relationship with CRT response.Methods A total of 35 patients consisting 25 males and 10 females,mean age 64.1 ± 9.7 （48-75 ）years old,who underwent CRT implantation for chronic heart failure were enrolled in this study.All patients were evaluated with conventional echocardiography before and 6 months after implantation.Cardiac function class （New York Heart Association,NYHA）was also assessed according to clinical performance.Medications such as beta-blocker and angiotensin-converting enzyme inhibitor （ACEI）were analyzed before and after CRT implantation.Patients were divided into responder group and non-responder group according to response to CRT. Beta-blocker and ACEI before and after CRT implantation were compared, respectively. Relationship between doses change of beta-blocker or ACEI and response to CRT were analyzed.Results There were 28 responders and 7 non-responders. Patients of responder group received larger metoprolol succinate therapy postoperatively compared with preoperatively（average daily dose 59.6±24.4 mg/d vs 25.0±1 1.0 mg/d,P 〈0.01）, while patients of non-responder group had no significantly change（average daily dose 25.0±8.8 mg/d vs 27.5 ±22.4 mg/d,P〉 0.05 ）.Patients of responder group received larger perindopril therapy postoperatively compared with preoperatively （average daily dose 4.74±1.52 mg/d vs 3.47±0.91 mg/d,P 〈0.05）,while patients of nonresponder group had no significantly change （average daily dose 3.60 ± 0.89 mg/d vs 3.80 ± 0.45 mg/d,P〉 0.05 ）. Furthermore,change of beta-blocker therapy had a good correlation with CRT response （r =0.688,P 〈0.01）,while change of ACEI therapy had a poor correlation with CRT response（r =0.355,P〉0.05）.Conclusion Response to cardiac resynchronization therapy correlated with optimal pharmacologic therapy postoperatively. Optimal pharmacologic therapy and CRT may work together to imp

关 键 词：心力衰竭 心脏起搏 人工 肾上腺素能Β受体拮抗剂 

分 类 号：R541.6[医药卫生—心血管疾病]