早期应用β受体阻滞剂治疗重度心力衰竭患者的疗效和安全性评价  

Evaluation of the Efficacy and Safety of Early Application ofβ-receptor antagonists in the Treatment of Patients with Severe Heart Failure

作　　者：廖火城[1] 刘建平[1] 郑如义[1] 肖纯[1] LIAO Huocheng;LIU Jianping;ZHENG Ruyi;XIAO Chun(Department of Cardiology,Third People's Hospital of Huizhou City,Huizhou 516002,China)

机构地区：[1]广东省惠州市第三人民医院心内科,广东惠州516002

出　　处：《中国医药指南》2020年第25期1-4,7,共5页Guide of China Medicine

基　　金：惠州市重点专科项目经费资助[(2018)205]。

摘　　要：目的探讨重度心力衰竭[美国纽约心脏协会(NYHA)心功能分级Ⅳb级]患者早期应用β受体阻滞剂治疗的临床疗效和安全性。方法将226例重度心力衰竭患者分为常规治疗组(110例)和倍他乐克治疗组(116例)。两组患者均实施常规治疗,倍他乐克治疗组患者在常规治疗的同时即给予酒石酸美托洛尔(商品名:倍他乐克)治疗,常规治疗组患者在常规治疗后待心力衰竭控制稳定后才开始应用倍他乐克治疗。观察比较两组患者治疗1周、6个月时的临床疗效;治疗前、治疗1周、治疗6个月的左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、24 h室性心律失常发生情况、24 h动态心电图心率变异性。结果两组患者治疗1周、6个月的治疗总有效率比较,统计学无显著性差异(P>0.05)。两组患者治疗1周、6个月的LVEF均较治疗前明显升高(P<0.05),但两组间比较统计学无显著性差异(P>0.05);两组患者治疗6个月的LVEDD均较治疗前有所缩小(P<0.05);但两组患者治疗1周、6个月的LVEDD组间比较统计学无显著性差异(P>0.05)。两组患者治疗1周、治疗6个月的平均24 h室性早搏发生次数及平均24 h室性心动过速发生次数均较治疗前明显减少,且治疗6个月均较治疗1周进一步减少(P<0.05);倍他乐克治疗组患者治疗1周、治疗6个月的平均24 h室性早搏发生次数及平均24 h室性心动过速发生次数均较常规治疗组减少更为明显(P<0.05)。常规治疗组患者治疗1周的总体标准差(SDNN)、相邻正常R-R间期差值>50 ms的百分比(pNN50)均较治疗前无明显改善(P>0.05);倍他乐克组患者治疗1周的SDDN、pNN50均较治疗前明显改善(P<0.05);两组患者治疗6个月的SDDN、pNN50均较治疗前、治疗1周显著改善(P<0.05);倍他乐克治疗组患者治疗1周、治疗6个月的SDDN、pNN50均较常规治疗组改善更为明显(P<0.05)。结论重度心力衰竭患者早期使用β受体阻滞剂治疗很可能是安�Objective To explore the clinical efficacy and safety of early application ofβ-receptor antagonists in patients with severe heart failure[New York Heart Disease Association(NYHA)heart function classificationⅣb].Methods The 226 patients with severe heart failure were divided into the conventional treatment group(110 cases)and the Betaloc treatment group(116 cases).Patients in the two groups received conventional treatment.Patients in the Betaloc treatment group were given metoprolol tartrate(trade name:Betaloc)at the same time as the conventional treatments.Patients in the conventional treatment group were treated with Betaloc after their heart failure was controlled and stabilized after conventional treatment.To observe and compare the clinical efficacy at 1 week and 6 months of treatment;the left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),the occurrence of 24 h ventricular arrhythmia and 24 h dynamic electrocardiogram heart rate variability of the two groups of patients before treatment,1 week of treatment,and 6 months of treatment.Results There was no statistically significant difference in the total effective rate of treatment between the two groups of patients for 1 week and 6 months of treatment(P>0.05).The LVEF of the two groups of patients after treatment for 1 week and 6 months were significantly higher than before treatment(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).The LVEDD of the two groups of patients treated for 6 months decreased compared with before treatment(P<0.05);but there was no statistically significant difference in the LVEDD of the two groups of patients treated for 1 week and 6 months(P>0.05).The average number of occurrences of 24-hour ventricular premature beats and average 24-hour ventricular tachycardia during 1 week of treatment and 6 months of treatment in the two groups of patients were significantly reduced compared to before treatment,and both 6 months of treatments were further reduced c

关 键 词：重度心力衰竭 Β受体阻滞剂 左室射血分数 室性心律失常 心率变异性 

分 类 号：R541.6[医药卫生—心血管疾病]