伊伐布雷定联合美托洛尔对缺血性心肌病患者PCI术后心功能的影响  

Effects of ivabradine combined with metoprolol on heart function in patients with ischemic cardiomyopathy after percutaneous coronary intervention

作　　者：朱耀文 张华巍[2] 孙志军[2] ZHU Yaowen;ZHANG Huawei;SUN Zhijun(Department of Cardiology,Beijing Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100039,China;Department of Cardiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]北京市中西医结合医院心内科,北京100039 [2]解放军总医院第一医学中心心内科,北京100853

出　　处：《解放军医学院学报》2019年第3期223-226,270,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨伊伐布雷定联合美托洛尔对缺血性心肌病(ischemic cardiomyopathy,ICM)患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后心功能的影响。方法选取2014年1月-2017年12月解放军总医院第一医学中心治疗的左心室射血分数(left ventricular ejection fraction,LVEF)值小于45%的缺血性心肌病并且行PCI术的患者87例,采用随机数表方法分为观察组(n=43)及对照组(n=44)。观察组在给予常规药物治疗的基础上起始量给予酒石酸美托洛尔6.25 mg联合伊伐布雷定2.5 mg,对照组起始量给予酒石酸美托洛尔片12.5 mg,分别于治疗前、治疗1个月后、3个月后观察两组B型尿钠肽(B-type natriuretuc peptide,BNP)水平、6 min步行试验(6-min walk test,6MWT)距离、心率及心脏超声指标,观察两组3个月后主要心脏不良事件发生率。结果治疗3个月后,观察组与对照组相比,BNP(ng/ml)水平明显下降(P <0.05),6MWT距离(m)显著增加(P <0.05),6MWT心率(/min)明显下降(P <0.05),LVEF、E/A明显提高,LVID-D、LVID-S明显减小(P均<0.05);治疗3个月后观察组心脏不良事件的发生率与对照组相比有一定降低(4.7%vs9.1%,P=0.021)。结论伊伐布雷定联合美托洛尔对ICM患者PCI术后心功能的改善优于单纯美托洛尔治疗,是一种安全有效的治疗方案。Objective To investigate the clinical effect of ivabradine combined with metoprolol on the cardiac function in patients with ischemic cardiomyopathy after percutaneous coronary intervention(PCI).Methods Clinical and follow-up data of 87 ischemic cardiomyopathy patients undergoing PCI in the First Medical Center,Chinese PLA General Hospital from January 2014 to December2017 were retrospectively analyzed.All the patients were randomly divided into the control group(n=44)and the observation group(n=43)according to different treatment methods.On the basis of conventional symptomatic and supportive treatment,the control group was treated with enalapril 12.5 mg qd,while the observation group was treated with ivabradine 2.5 mg combined with metoprolol 6.25 mg qd.The BNP level,6-min walk test(6 MWT)and echocardiographic indexes were detected before treatment,at 1 month,and 3 months after treatment,the incidence of cardiac adverse events was also monitored.Results At 3 months after treatment,compared with control group,the BNP level and heart rate of 6 MWT in the observation group were signicantly lower,while the distance of 6 MWT was signicantly greater(all P<0.05).Compared with the control group,LVEF and E/A in the observation group signicantly increased,while LVID-D and LVID-S signicantly decreased(P<0.05).The incidence of cardiac adverse events in the observation group was signicantly lower than that of the control group(4.7%vs 9.1%,P=0.021).Conclusion Ivabradine combined with metoprolol is effective in the treatment of ischemic cardiomyopathy after PCI,which can signicantly improve the cardiac function and reduce cardiac adverse events.

关 键 词：伊伐布雷定 经皮冠状动脉介入治疗 美托洛尔 缺血性心肌病 心功能不全 

分 类 号：R541.4[医药卫生—心血管疾病]