伊伐布雷定对急性ST段抬高型心肌梗死患者心功能改善作用的研究  

Effect of ivabradine on heart function improvement in patients with acute ST-segment elevation myocardial infarction

作　　者：马桂伶[1] 关晓楠[1] 李飞鸥 齐丹[1] 魏妤[1] 张建军[1] Ma Guiling;Guan Xiaonan;Li Fei'ou;Qi Dan;Wei Yu;Zhang Jianjun(Department of Cardiology,Bejing Key Laboratory of Hypertension Disease,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院心内科高血压病研究北京市重点实验室、首都医科大学心血管疾病研究所,北京100043

出　　处：《中国循证心血管医学杂志》2023年第4期481-484,494,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 评价伊伐布雷定控制心率对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后左心功能的改善作用。方法 回顾性纳入2019年7月至2021年12月于北京朝阳医院西区心内科住院行急诊PCI且术后静息心率>80次/min的STEMI患者,根据是否服用伊伐布雷定分为伊伐布雷定组和对照组。通过医院信息系统收集患者基本信息、住院及出院3个月门诊随访资料,包括心率、血压,血常规、肝肾功、N末端脑钠肽前体(NT-proBNP)等化验指标,左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF)等超声指标,记录住院及随访期间心源性死亡、急性左心衰、心衰再住院、心绞痛再住院及药物不良反应。结果 共纳入146例患者,其中伊伐布雷定组70例,对照组76例。两组患者均接受标准冠心病二级预防治疗。出院时伊伐布雷定的日剂量为6.6±2.7 mg,伊伐布雷定的服用疗程为28.0±7.7 d。采用重复测量方差分析法比较两组间心率、血压、心功能相关指标的差异,发现伊伐布雷定组患者的心率控制优于对照组(P<0.01),LVEDD、LVEF的改善更显著(P<0.05)。随访期间两组患者均无心源性死亡,住院期间伊伐布雷定组3例、对照组4例患者急性左心衰发作,门诊随访期间对照组3例因心衰加重再入院、2例因心绞痛再住院。伊伐布雷定组2例患者心率<50次/min,伊伐布雷定减量后心率恢复正常。结论 联合使用伊伐布雷定有助于逆转急性STEMI患者左心室重构、改善心功能且安全性耐受性好。Objective To review the effect of heart rate control of ivabradine in improving left heart function in patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods STEMI patients undergone emergency PCI with rest heart rate>80 bpm were retrospectively chosen from Department of Cardiology in Beijing Chaoyang Hospital from July 2019 to Dec.2021.All patients were divided,according to whether taking ivabradine or not,into ivabradine group and control group.The basic information,materials of hospitalization and outpatient follow-up after discharged for 3 months were collected from hospital information system(HIS),including heart rate(HR),blood pressure(BP),blood routine examinations,liver and kidney functions and N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end-diastolic inner diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF).The incidence rates of cardiac death,acute left heart failure(LHF),rehospitalization due to HF,re-hospitalization due to angina pectoris(AP)and adverse drug reactions(ADR)were recorded during hospitalization and follow-up periods.Results There were totally 146 patients selected,and 70 in ivabradine group and 76 in control group.Both groups received standard secondary preventive treatment for coronary heart disease(CHD).At discharge,the daily dosage of ivabradine was(6.6±2.7)mg,and the course of treatment with ivabradine was(28.0±7.7)d.The differences in indexes related to HR,BP and heart function were compared by using repeated measures ANOVA between 2 groups,and the results showed that HR control was better(P<0.01)and improvements of LVEDD and LVEF were more significant in ivabradine group than those in control group(all P<0.05).During follow-up period,there was no case of cardiac death.During hospitalization period,there were 3 cases of acute LHF in ivabradine group and 4 cases in control group.During outpatient follow-up period,there were 3 c

关 键 词：急性心肌梗死 伊伐布雷定 左心室重构 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]