伊伐布雷定对高龄老年慢性心力衰竭患者心率及心功能的影响  

Effect of Ivabradine on Heart Rate and Cardiac Function of Elderly Patients with Chronic Heart Failure

作　　者：陈艳梅 武云涛 田国祥[1] 姚璐 刘立新[1] 张薇 CHEN Yanmei;WU Yuntao;TIAN Guoxiang;YAO Lu;LIU Lixing;ZHANG Wei(Department Four of Cadre Ward,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心干部病房四科

出　　处：《医学综述》2019年第23期4767-4770,4775,共5页Medical Recapitulate

基　　金：军队保健专项科研课题(15BJZ03);全军“十二五”课题(CWS11J216)

摘　　要：目的探讨伊伐布雷定对高龄老年慢性心力衰竭(CHF)患者心率及心功能的影响。方法选取2017年1月至2019年1月在解放军总医院第七医学中心老年心血管内科就诊的高龄老年CHF患者105例,按照是否使用伊伐布雷定片治疗分为对照组(50例)和观察组(55例),其中对照组予以标准化抗心力衰竭治疗,观察组在对照组的基础上加服伊伐布雷定片,共治疗12周。观察两组患者治疗前后的心率、血浆脑钠肽(BNP)、左心室射血分数(LVEF)、6分钟步行距离(6MWD)变化,并记录治疗期间药物相关不良反应。结果治疗12周后,两组患者的心率和血浆BNP水平显著降低,且观察组低于对照组[(59.6±4.9)次/min比(68.6±5.0)次/min,(195.6±37.9)ng/L比(318.5±38.5)ng/L](P<0.05);LVEF水平较治疗前升高,但治疗后观察组与对照组比较差异无统计学意义(P>0.05);6MWD显著增加,且观察组大于对照组[(289.6±44.9)m比(228.6±45.0)m](P<0.05)。观察组的不良反应发生率为3.63%(2/55),对照组为4.0%(2/50),两组不良反应发生率比较差异无统计学意义(P>0.05)。结论伊伐布雷定可显著降低高龄老年CHF患者的心率、血浆BNP水平,提高运动耐量,明显改善心功能,具有较好的安全性。Objective To explore the effect of ivabradine on the heart rate and heart function in elderly patients with chronic heart failure(CHF).Methods A total of 105 elderly CHF patients from the Department of Cardiovascular Medicine of the Seventh Medical Center of PLA General Hospital from Jan.2017 to Jan.2019 were included in the study,according to whether ivabradine was used,the patients were divided into a control group(50 cases)and an observation group(55 cases).The control group was treated with standardized anti-heart failure therapy,and the observation group was added with ivabradine on the basis of the control group′s regimin,for 12 weeks.The changes of heart rate,plasma brain natriuretic peptide(BNP),left ventricle ejection fraction(LVEF)and 6-minute walk distance(6MWD)were observed before and after treatment,and the adverse drug reactions were recorded.Results After 12 weeks treatment,the heart rate and plasma BNP level of the two groups were significantly lower than before treatment,and the observation group lower than the control group[(59.6±4.9)times/min vs(68.6±5.0)times/min,(195.6±37.9)ng/L vs(318.5±38.5)ng/L](P<0.05);LVEF level was higher than before treatment,but there was no significant difference between the observation group and the control group(P>0.05);6MWD was significantly increased,and the observation group higher than the control group[(289.6±44.9)m vs(228.6±45.0)m](P<0.05).The incidence of adverse reaction was 3.63%(2/55)in the observation group and 4.0%(2/50)in the control group;there was no significant difference in adverse effects between the two groups(P>0.05).Conclusion Ivabradine can significantly reduce the heart rate and plasma BNP level,improve exercise tolerance,and significantly improve heart function of the elderly CHF patients,with better safety.

关 键 词：慢性心力衰竭 伊伐布雷定 心率 脑钠肽 老年 

分 类 号：R541.6[医药卫生—心血管疾病]