伊伐布雷定联合沙库巴曲缬沙坦治疗慢性充血性心力衰竭的临床研究  

Clinical efficacy of ivabradine combined with sakubatril valsartan on chronic congestive heart failure

作　　者：戴雯莉[1] 张京梅[1] 林运[1] 孙涛[1] 李志忠[1] 孙俊平[1] 陶英[1] 高玉龙[1] Dai Wenli;Zhang Jingmei;Lin Yun;Sun Tao;Li Zhizhong;Sun Junping;Tao Ying;Gao Yulong(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China.)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国循证心血管医学杂志》2021年第5期566-569,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：山西省科技厅重点研发计划(201903D321177);一般项目合作课题(山西首钢长钢医院-首都医科大学附属北京安贞医院)。

摘　　要：目的研究伊伐布雷定联合沙库巴曲缬沙坦治疗慢性充血性心力衰竭(CHF)的临床疗效。方法选取2017年4月至2020年4月于北京安贞医院心内科住院及门诊就诊的病情稳定的CHF患者。两组患者均使用沙库巴曲缬沙坦治疗,一组在标准抗心力衰竭(心衰)治疗的基础上,窦性心率仍>70次/min的68例患者,予以伊伐布雷定治疗(伊伐布雷定组),并选取同期就诊的已接受沙库巴曲缬沙坦为基础的标准抗心衰治疗,但因各种原因未使用伊伐布雷定治疗的CHF患者66例(对照组)。伊伐布雷定初始剂量为2.5 mg/次,2/d,根据心率调整剂量,最大量7.5 mg/次,2/d。控制患者的静息心率60次/min左右,连续用药6个月,纪录两组用药前后心率(HR)、N末端脑钠肽前体(NT-proBNP)、6 min步行距离(6MWD)、心脏彩超测定左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD),并记录药物的不良反应。结果加用伊伐布雷定前两组比较,HR、NT-proBNP、6MWD、LVEF、LVEDD、LVESD无统计学差异(P均>0.05),治疗6个月后,伊伐布雷定组与对照组比较,HR、NT-proBNP、LVEDD、LVESD降低(P<0.05),6MWD、LVEF增加(P<0.05)。伊伐布雷定组治疗6个月后与治疗前比较,HR显著下降(68.5±10.1 vs.81.2±7.7次/min),NT-proBNP水平也显著下降(455±51 ng/L vs.2510±506 ng/L),LVEDD有显著下降(51±4 mm vs.61±6 mm),LVESD显著下降(33.2±0.9 mm vs.42.1±1.3 mm),6MWD显著增加(198±55 m vs.110±55 m),LVEF显著增加(40.0±6.0%vs.31.0±7.0%)。治疗前后比较差异有统计学意义(P<0.05),且药物不良反应少。结论伊伐布雷定联合沙库巴曲缬沙坦治疗能够降低CHF患者的心率,改善心功能,提高运动耐力,且不增加不良反应发生率,改善CHF患者的生活质量,减少疾病复发,安全、有效。Objective To study the clinical efficacy of ivabradine combined with sakubatril valsartan on chronic congestive heart failure(CHF).Methods CHF patients(n=68)were chosen from Department of Cardiology of Beijing Anzhen Hospital from Apr.2017 to Apr.2020.All patients were treated with sakubatril valsartan,and 68 patients with sinus heart rate(HR)>70 time/min the basis of optimized anti-CHF treatment were given ivabradine treatment(ivabradine group),and 66 patients undergone optimized anti-HF treatment without ivabradine treatment(control group)were chosen at the same time.The initial dose of ivabradine was 2.5 mg/time twice a day,and the dose was adjusted according to HR,up to a maximum of 7.5 mg/time twice a day.The resting heart rate was maintained at about 60 time/min for 6 months.The changes of HR,NT-proBNP and 6MWD were recorded,levels of LVEF,LVEDD and LVESD were detected by using color Doppler ultrasonography,and drug adverse reactions were recorded.Results Before ivabradine treatment,there was no statistical difference in HR,NT-proBNP,6MWD,LVEF,LVEDD and LVESD between 2 groups(all P>0.05).After ivabradine treatment for 6 months,HR,NT-proBNP,LVEDD and LVESD decreased(P<0.05),and 6MWD and LVEF increased(P<0.05)in ivabradine group compared with control group.The comparison in ivabradine group before and after ivabradine treatment for 6 months showed that HR[(68.5±10.1)time/min vs.(81.2±7.7)time/min],NT-proBNP[(455±51)ng/L vs.(2510±506)ng/L],LVEDD[(51±4)mm vs.(61±6)mm]and LVESD[(33.2±0.9)mm vs.(42.1±1.3)mm]decreased significantly,and 6MWD[(198±55)m vs.(110±55)m]and LVEF[(40.0±6.0)%vs.(31.0±7.0)%]increased significantly(all P<0.05).There were few drug adverse reactions recorded.Conclusion Ivabradine combined with sakubatril valsartan can reduce HR, improve heart function and exercise endurance without increasing incidencerates of adverse effects, improve the quality of life and reduce the recurrence in CHF patients. It is safe andeffective for treating CHF.

关 键 词：心力衰竭 伊伐布雷定 沙库巴曲缬沙坦 

分 类 号：R541.61[医药卫生—心血管疾病]