通痹宁心汤联合美托洛尔对缺血性心肌病心力衰竭患者心率变异性、跨室壁复极离散度和主要心脏不良事件的影响  

Effect of Tongbi Ningxin Decoction combined with metoprolol on heart rate variability, transmural dispersion of repolarization and major adverse cardiac events in patients with ischemic cardiomyopathy and heart failure

作　　者：吕晓燕 胡小菁 LYU Xiaoyan;HU Xiaojing(The Ninth Hospital of Xi’an,Xi’an 710054,Shaanxi,China)

机构地区：[1]陕西省西安市第九医院

出　　处：《现代中西医结合杂志》2019年第29期3228-3232,3259,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察通痹宁心汤联合美托洛尔对缺血性心肌病心力衰竭患者心率变异性(HRV)、跨室壁复极离散度(TDR)和主要心脏不良事件(MACE)的影响。方法将100例缺血性心肌病心力衰竭患者随机分为观察组(50例)和对照组(50例),2组均接受常规治疗,对照组在常规治疗基础上给予美托洛尔治疗,观察组在对照组的基础上给予通痹宁心汤治疗,连续用药8周。观察2组治疗后临床症状体征、心功能指标、HRV、TDR的改善情况;治疗后随访6个月,记录2组MACE发生率。结果2组治疗后胸闷胸痛、心悸气短、气喘咳嗽、尿少、面肢水肿、神疲乏力发生率均显著降低(P均<0.05),且观察组均显著低于对照组(P均<0.05)。2组治疗后左心室舒张末期内径(LVEDD)、血清B型脑钠肽(BNP)、Lee氏心衰评分和TDR指标QTc、QTd、Tp-e、Tp-e/QTc均显著低于治疗前(P均<0.05),左心室射血分数(LVEF)、E/A和HRV相关指标SDANN、rMSSD、SDNN、PNN50%均显著高于治疗前(P均<0.05),观察组治疗后以上指标改善情况均显著优于对照组(P均<0.05)。随访6个月,观察组MACE总发生率显著低于对照组(P<0.05)。结论通痹宁心汤联合美托洛尔可显著缓解缺血性心肌病心力衰竭患者临床症状,提高心脏功能,改善患者HRV和TDR,降低MACE发生风险,值得临床推荐。Objective It is to observe the effects of Tongbi Ningxin Decoction combined with metoprolol on heart rate variability(HRV),transmural dispersion of repolarization(TDR)and major adverse cardiac events(MACE)in patients with ischemic cardiomyopathy and heart failure.Methods One hundred patients with ischemic cardiomyopathy with heart failure were randomly divided into observation group(50 cases)and control group(50 cases).Both groups received routine treatment.The control group was treated with metoprolol on the basis of conventional treatment.The observation group was treated with Tongbi Ningxin Decoction on the basis of the control group.Both groups were treated for 8 weeks.The improvement of clinical symptoms and signs,cardiac function,HRV and TDR were observed after treatment.All the patients were followed up for 6 months.The incidence of MACE was recorded.Results After treatment,the incidence rates of chest pain,chest palpitations,shortness of breath,cough,oliguria,facial edema,and fatigue were significantly decreased in the two groups(P<0.05),and the rates in the observation group were significantly lower than that in the control group(P<0.05).Left ventricular end-diastolic diameter(LVEDD),serum B-type brain natriuretic peptide(BNP),Lee’s heart failure score,and TDR indicators QTc,QTd,Tp-e,and Tp-e/QTc were significantly lower after treatment(P<0.05),while left ventricular ejection fraction(LVEF),E/A and HRV related indicators SDANN,rMSSD,SDNN,PNN50%were significantly higher than those before treatment in the two groups(P<0.05),the improvements of the above indicators after treatment in the observation group were significantly better than those in the control group(P<0.05).After 6 months of follow-up,the overall incidence of MACE in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Tongbi Ningxin Decoction combined with metoprolol can significantly alleviate the clinical symptoms,improve cardiac function,improve HRV and TDR,and reduce the risk of MACE in patients

关 键 词：通痹宁心汤 美托洛尔 缺血性心肌病 心力衰竭 心率变异性 跨室壁复极离散度 主要心脏不良事件 

分 类 号：R541.6[医药卫生—心血管疾病]