接受心血管植入型电子器械治疗的心力衰竭患者术后心率管理的研究  

Heart rate control in chronic heart failure patients received cardiovascular implantable electronic device therapy： effects of optimized medication

作　　者：高阳[1] 梁延春[1] 于海波[1] 焉晓蕾 徐白鸽[1] 刘荣[1] 王娜[1] 许国卿[1] 王祖禄[1] Gao Yang, Liang Yanchun, Yu Haibo, Yan Xiaolei, Xu Baige, Liu Rong, Wang Na, Xu Guoqing, Wang Zulu(Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China)

机构地区：[1]沈阳军区总医院心血管内科,110016

出　　处：《中华心血管病杂志》2018年第3期173-177,共5页Chinese Journal of Cardiology

基　　金：国家重点研发计划（2016YFC0900904）

摘　　要：目的观察接受心血管植入型电子器械治疗的慢性心力衰竭（心衰）患者心率控制情况，并评价规范化调整药物治疗对其的影响。方法前瞻性入选2012年1月至2017年1月符合指南推荐并接受了心血管植入型电子器械治疗的射血分数降低的心衰患者150例。随访时，记录患者静息心率（RHR）及最近1个月的用药情况。以RHR〈70次/min为达标标准，统计RHR达标率，对于未达标的患者在调整β受体阻滞剂用量至靶剂量或最大可耐受剂量后，如仍不达标则加用伊伐布雷定，比较药物调整前后RHR达标率。结果150例患者基线RHR为（80.6±11.9）次/min，达标率为27.3%（41/150），未达标的患者中80.7%（88/109）β受体阻滞剂应用剂量未达指南推荐的靶剂量，在调整β受体阻滞剂用量至靶剂量或最大可耐受剂量后，入选患者总体RHR降至（73.1±10.4）次/min，RHR达标率上升至70.0%（105/150），较调整前显著改善（χ2=52.958，P〈0.001）。对RHR仍未达标的45例患者经加用并调整伊伐布雷定剂量后。ObjectiveTo investigate the heart rate control situation of chronic heart failure （CHF） patients who received cardiovascular implantable electronic device （CIED） therapy, and to assess the heart rate control efficacy by optimized medication adjustment.MethodsWe performed a perspective study in heart failure with reduced left ventricular ejection fraction （HFrEF） patients who received CIED according to guideline recommendations, patients were enrolled from January 2012 to January 2017. Resting heart rate （RHR） recorded by electrocardiogram after 10 minutes＇ rest and medication usage within 1 month were recorded at baseline. RHR less than 70 beats per minute （bpm） was regarded as well controlled. β-receptor blockers and （or） ivabradine would be added in patients whose RHR were over 70 bpm. RHR after optimized medication adjustment was recorded during follow-up period.ResultsOne hundred and fifty patients were included in this study with average RHR （80.6±11.9） bpm. RHR was〈70 bpm in 27.3% （41/150） patients at baseline and β-receptor blockers was underused in 80.7% patients （88/109） whose RHR was〉70 bpm. The overall RHR decreased to （73.1±10.4） bpm and percent of patients with RHR〈70 bpm increased to 70.0% （105/150） after up-titration of β-receptor blockers compared to baseline （χ2=52.958, P〈0.001）. Ivabradine was added in the rest 45 patients and RHR was〈70 bpm in 43 out of 45 patients after ivabradine use. The overall RHR decreased to （67.1±2.7） bpm and percent of RHR〈70 bpm significantly increased to 98.7% （148/150） （χ2=44.504, P〈0.001 vs. up-titration of β-receptor blockers only）.ConclusionRHR in CHF patients who received CIED therapy is not ideally controlled in this patient cohort, individual up-titration ofβ-receptor blockers and ivabradine use may help to optimize RHR in these patients.

关 键 词：心力衰竭 心率 肾上腺素能Β受体拮抗剂 伊伐布雷定 心血管植入型电子器械 

分 类 号：R541.6[医药卫生—心血管疾病]