伊伐布雷定在慢性射血分数降低心力衰竭易损期的运用及再入院影响因素分析  

The application of ivabradine in chronic heart failure with reduced ejection fraction in vulnerable stage and the influencing factors of readmission in vulnerable stage

作　　者：柯子奋 梁妍 吴庆法 李庆军[1] KE Zi-fen;LIANG Yan;WU Qing-fa;LI Qing-jun(Department of the First Cardiology,Central People's Hospital of Zhanjiang,Zhanjiang 524045,China)

机构地区：[1]广东省湛江中心人民医院心内一科,524045

出　　处：《天津医药》2021年第1期59-63,共5页Tianjin Medical Journal

基　　金：湛江市科技计划项目(2019B01174)。

摘　　要：目的探讨伊伐布雷定(Iva)在慢性射血分数降低心力衰竭(HFrEF)易损期的运用及易损期再入院的影响因素。方法根据是否服用Iva把402例易损期慢性HFrEF患者分为对照组(142例)和观察组(260例)。对照组依据指南给与抗心力衰竭治疗,观察组在对照组的基础上给与Iva。对比2组的疗效、心脏不良事件、心功能指标、炎性因子。采用Logistic回归分析易损期慢性HFrEF患者再入院的影响因素。结果观察组的疗效明显好于对照组,再住院比例明显低于对照组(P<0.05)。治疗后与对照组相比,观察组的24 h平均心率减慢,左心室射血分数(LVEF)增高,左心室舒张末期内径(LVEDD)减小,6 min步行距离(6MWD)延长,N末端B型利钠肽原(NT-proBNP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6和超敏C-反应蛋白(hs-CRP)水平均降低(P<0.05或P<0.01)。Logistic回归分析结果显示不按时服药、独居是易损期慢性HFrEF患者再入院独立危险因素,而每周复诊1次则是独立保护因素。结论Iva可提高易损期慢性HFrEF的疗效,降低易损期再入院率和炎性因子水平,同时可改善心功能指标。不按时服药和独居的慢性HFrEF患者在易损期更容易再入院,而每周复诊1次则可降低再入院率。Objective To investigate the application of ivabradine(Iva)in chronic heart failure with reduced ejection fraction(HFrEF)in vulnerable stage and the influencing factors for readmission in vulnerable stage.Methods A total of 402 patients with chronic HFrEF in vulnerable stage were divided into control group(n=142)and observation group(n=260)according to whether they took Iva.The control group was given anti-heart failure treatment according to the guidelines,and the observation group was given treatment with Iva on the basis of the control group.The curative effect,cardiac adverse events,cardiac function indexes and inflammatory factors were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of readmission of patients with chronic HFrEF in vulnerable stage.Results The curative effect was better in the observation group than that of the control group(P<0.05).The proportion of rehospitalization was significantly lower in the observation group than that in the control group(P<0.05).After treatment,the 24-hour mean heart rate was significantly decreased in the observation group compared with that of the control group.LVEF was significantly higher,LVEDd was significantly smaller,6MWD was significantly longer,and the concentrations of NT proBNP,TNF-α,IL-6 and hs-CRP were significantly lower in the observation group compared with those of the control group(P<0.05 or P<0.01).Logistic regression analysis showed that not taking medicine on time and living alone were independent risk factors for readmission of patients with chronic HFrEF in vulnerable stage,and weekly follow-up visit was an independent protective factor.Conclusion Iva can improve the efficacy of chronic HFrEF in the vulnerable period,reduce the readmission rate and the concentration of inflammatory factors in the vulnerable period,and improve the cardiac function index.Patients with chronic HFrEF who do not take medicine on time and lived alone are more likely to be readmitted during the vulnerable s

关 键 词：心力衰竭 伊伐布雷定 射血分数降低心力衰竭 易损期 再入院 影响因素 

分 类 号：R541[医药卫生—心血管疾病]