伊伐布雷定治疗肺动脉高压致右心功能不全伴窦性心动过速患者的有效性和安全性研究  

Efficacy and Safety of Ivabradine in the Treatment of Right Heart Failure With Sinus Tachycardia Caused by Pulmonary Hypertension

作　　者：何晓全 周力[1] 高翔宇[1] 邱惠[1] 姚道阔[1] 沈爱东[1] 赵树梅[1] 赵慧强[1] 陈晖[1] HE Xiaoquan;ZHOU Li;GAO Xiangyu;QIU Hui;YAO Daokuo;SHEN Aidong;ZHAO Shumei;ZHAO Huiqiang;CHEN Hui(Cardiovascular Center,Capital Medical University Affiliated Beijing Friendship Hospital,Beijing(100015),China)

机构地区：[1]首都医科大学附属北京友谊医院心脏中心,北京市100015

出　　处：《中国循环杂志》2022年第5期472-476,共5页Chinese Circulation Journal

基　　金：北京友谊医院科研科研启动基金资助项目(yyqdkt2017-33);北京市医管局科研培育计划(PX2017030);北京市临床重点专科项目(2018-204)。

摘　　要：目的:观察伊伐布雷定治疗肺动脉高压致右心功能不全伴窦性心动过速患者的有效性和安全性。方法:分析2018年1月至2020年10月在首都医科大学附属北京友谊医院住院治疗的肺动脉高压致右心功能不全伴窦性心动过速患者25例,在规范治疗基础上加用伊伐布雷定(2.5~7.5 mg,2次/d)治疗,观察患者临床症状改善情况、超声心动图指标及治疗期间不良反应的发生情况。结果:经伊伐布雷定治疗后,患者心率较治疗前明显下降[(73.3±8.2)次/min vs.(96.9±9.2)次/min,P<0.001]。25例患者中11例患者的心功能改善,16例呼吸困难患者中14例症状显著改善。与治疗前相比,治疗后6分钟步行距离、N末端B型利钠肽原(NT-proBNP)水平、左心室舒张末期内径、左心室射血分数、三尖瓣反流峰速、收缩期肺动脉压、下腔静脉内径均显著改善(P均<0.05),左心房前后径和右心室前后径与治疗前相比无显著变化(P均>0.05)。1例患者应用伊伐布雷定后出现光幻视现象,减量后光幻视症状消失,无不良心血管事件发生。结论:对于肺动脉高压致右心功能不全伴窦性心动过速患者,在常规药物治疗基础上加用伊伐布雷定可有效降低心率和肺动脉压,改善左心室功能及临床症状,且不良反应轻微。Objectives:To observe the efficacy and safety of ivabradine on top of standard medication in the treatment of patients with right heart failure with sinus tachycardia caused by pulmonary hypertension.Methods:A total of 25 patients with right heart failure with sinus tachycardia caused by pulmonary arterial hypertension,who were hospitalized in Capital Medical University Affiliated Beijing Friendship Hospital from January 2018 to December 2020,were included in this study.On top of standard medication including oxygen therapy,diuretics and cardiovascular drugs,ivabradine treatment(2.5-7.5 mg twice/day)was added to these patients.Heart rate and biventricular function before and after the treatment of ivabradine were compared.Clinical symptoms and the occurrence of adverse reactions during treatment were also observed.Results:After treatment with ivabradine,the heart rate was significantly lower than before the treatment([73.3±8.2]beat/min vs.[96.9±9.2]beat/min,P<0.001),NYHA heart function classification improved in 11 patients,and dyspnea symptoms were relieved in 14 out of 16 symptomatic patients.After the ivabradine treatment,the 6-minute walk distance,NT-proBNP level,left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),tricuspid regurgitation velocity(TRV),systolic pulmonary artery pressure(SPAP),and inferior vena cava diameter(IVCD)were all significantly improved as compared with before treatment levels(all P<0.05).The anteroposterior diameter of the left atrium and the right ventricle remained unchanged post treatment(all P>0.05).During the treatment of ivabradine,one patient had phoenixes and the symptoms disappeared after the dose of ivabradine was reduced.There were no adverse cardiovascular events such as bradycardia,high-grade atrioventricular block,malignant arrhythmia,and cardiogenic shock after ivabradine treatment.Conclusions:Adding ivabradine on top of standard medication is safe and can effectively reduce heart rate and pulmonary artery pressure,improve left ventr

关 键 词：伊伐布雷定 肺动脉高压 右心衰竭 心功能 

分 类 号：R54[医药卫生—心血管疾病]