美托洛尔联合阿托伐他汀治疗对心力衰竭患者心率变异性及远期疗效的影响  

Impact of Metoprolol combined with Atorvastatin on heart rate variability and long-term effect in patients with heart failure

作　　者：谢阳[1] 周浩粤[1] 黄伟鹏[1] 林宇鹏[1] 张华弟[1] 

机构地区：[1]广东省揭阳市人民医院心血管内科,广东揭阳522000

出　　处：《中国当代医药》2017年第19期39-43,共5页China Modern Medicine

摘　　要：目的探讨美托洛尔联合阿托伐他汀治疗对慢性心力衰竭(CHF)患者心率变异性及远期疗效的影响。方法采用病例对照研究设计,按一定入组标准回顾性选取2011年1月~2012年12月我院收治的CHF患者,病例组为符合入组标准同时使用阿托伐他汀治疗的患者,对照组为符合入组标准而未使用他汀类药物治疗的患者。以开始使用他汀的时间点作为纳入对照的基本匹配条件(入组时间相差在1周以内),同时匹配年龄和性别。最终共入组120例患者,将其分别作为病例组和对照组,各60例,两组均使用含美托洛尔的CHF标准治疗。随访12个月,观察两组患者治疗前和治疗6个月后心功能和心率变异性各项指标的变化,于治疗前和治疗12个月后采用SF-36量表对两组患者的生活质量进行评分,比较两组患者6、12个月的生存情况及治疗期间不良反应发生情况。结果病例组患者治疗6个月后的左室射血分数(LVEF)为(49.38±6.42)%,显著高于对照组的(43.34±6.18)%,两组差异有统计学意义(P<0.05);病例组患者治疗6个月后的左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)分别为(60.39±3.02)、(41.25±5.68)mm,均显著低于对照组的(63.94±2.67)、(46.73±5.76)mm,两组差异有统计学意义(P<0.05);病例组患者治疗6个月后的24 h所有窦性心搏R-R间期的标准差(SDNN)、24 h每5分钟窦性心搏R-R间期平均值的标准差(SDANN)、相邻窦性心搏R-R间期差值的均方根(r MSSD)和24 h相邻窦性心搏R-R间期差值>50 ms的百分比(PNN50)分别为(116.79±20.54)ms、(108.22±13.04)ms、(22.74±6.12)ms和(12.76±4.83)%,均显著高于对照组的(92.38±18.72)ms、(92.31±12.58)ms、(15.73±5.78)ms和(8.29±2.74)%,两组差异有统计学意义(P<0.05);病例组患者治疗12个月后的生理功能、生理职能、躯体疼痛、总体健康、社会功能、活力、情感职能和精神健康共8个维度的评分均高于对照组,两组差异有统计学意Objective To discuss the impact of Metoprolol combined with Atorvastatin on heart rate variability and long-term effect in patients with heart failure.Methods A case-control study design was used.Patients with chronic heart failure treated in our hospital from January 2011 to December 2012 were retrospectively selected according to the certain entry criteria.The case group was patients matching the entry criteria and given Atorvastatin treatment and the control group was patients matching the entry criteria and had no Atorvastatin treatment.The timing of initiation of statin use was used as a basic matched condition for including control （within 1 weeks of admission）,while matching age and sex.120 patients were included with 60 cases in case group and 60 cases in control group.Standardized treatment including Metoprolol of CHF was used in each group.After 12-month follow-up,each index change of heart function and heart rate variability before treatment and after 6 months treatment in patients of the two groups were observed.Before treatment and after 12 months treatment,SF-36 scale was used to evaluate the quality of life score in patients of the two groups.The survival state and adverse reactions of 6 and 12 months during treatment were compared between the two groups.Results LVEF was （49.38±6.42）% in case group after 6-months treat ment,which was higher than that in control group [（43.34±6.18）%],and the difference was statistically significant （P〈0.05）.LVEDD and LVESD were （60.39±3.02） mm and （41.25±5.68） mm in case group after 6-months treatment,which were lower than that in control group [（63.94±2.67）,（46.73±5.76） ram] and the difference was statistically significant （P〈0.05）.SDNN,SDANN,rMSSD and PNN50 were （116.79±20.54） ms,（108.22±13.04） ms,（22.74±6.12） ms and （12.76±4.83）% in case group after 6-months treatment,which were all higher than that in control group [（92.38＋18.72） ms,（92.31±12.58） ms,（15.73±5.78） ms,（8.29± 2.74�

关 键 词：美托洛尔 阿托伐他汀 心力衰竭 心率变异性 死亡率 

分 类 号：R541.61[医药卫生—心血管疾病]