冠心病伴心力衰竭合并心房颤动的心室率控制研究  

Heart Rate Control in Coronary Heart Disease with Heart Failure and Chronic Permanent Atrial Fibrillation

作　　者：岑明秋 陆明[2] 胡鹏飞[2] 吴迦勒[2] 马旭辉[2] 陈超[2] 黄抒伟[2] 

机构地区：[1]杭州市西溪医院(杭州市第六医院)心内科,310023 [2]浙江中医药大学附属第二医院(浙江省新华医院)心内科,310005

出　　处：《医学研究杂志》2015年第5期118-120,共3页Journal of Medical Research

摘　　要：目的探讨心室率控制对冠心病伴心力衰竭合并心房颤动（以下简称房颤）患者心功能的影响。方法160例冠心病伴心力衰竭合并房颤患者随机分成两组即高心室率组和低心室率组，两组患者均经美托洛尔缓释片单药或联合胺碘酮控制心室率，治疗目标：高心室率组为80次／分≤心室率〈100次／分，低心室率组为60次／分≤心室率〈80次／分。根据心室率达目标值后开始进入观察期2年。观察2年内患者临床心力衰竭症状变化、心绞痛发作情况、血清N端脑钠素前体（NT-proBNP）浓度、左室舒张末期内径变化。结果治疗前两组各项数据无统计学差异，治疗后高心室率组临床心功能不全情况优于低心室率组，两组心绞痛发作情况无明显差别。NT-proBNP、左心室舒张末期内径在治疗后两组均有下降，但高心室率组下降更显著（P〈0．01）。结论冠心病伴心力衰竭合并慢性房颤患者的心室率控制在80～100次／分相对优于60～80次／分。Objective To explore the influence of heart rate （HR） control in coronary heart disease （CHD）patients with chronic heart failure（CHF） and coexistent permanent atrial fibrillation（AF）. Methods A total of 160 coronary heart disease patients with chronic heart failure and coexistent permanent atrial fibrillation were included in the study. All patients received metoprolol sustained - release tablet or and amiodarone therapy to control HR. Then they were examined for relaxed heart rate and were divided into high HR group （8Or/ rain ~〈 HR 〈 100r/min） and a low HR group （60r/min ≤ HR 〈 80r/min）. All patients were followed up for 2 years. The changes of heart failure symptoms, angina oceuranee, NT - proBNP and Left ventricular end diastolic diameter （LVEDd） were observed. Results Before the treatment there was no statistical difference. After the treatment, the high HR group was significantly better than the low group in clini- cal symptoms for HF reason（P 〈 O. 01 ）. No differcence in angina occurance was found in both groups. NT - proBNP and LVEDd were significantly decreased after ＇the treatment （ P 〈 0. O1 ） , but the efficiency of high HR group was significantly better. Conclusion It is maybe better to control HR among 80 - lOOr/min than 60 - 80r/rain for the coronary heart disease patients suffering from the I-IF combined chronic permanent atrial fibrillation.

关 键 词：冠心病 心室率 慢性心房颤动 心力衰竭 

分 类 号：R5[医药卫生—内科学]