伊伐布雷定对慢性心力衰竭患者QT间期和心率的影响  

Effect of ivabradine on QT interval and heart rate in patients with chronic heart failure

作　　者：邸成业[1] 王群[1] 吴岩熹 李龙雨 张岩[1] 林文华[1] DI Chengye;WANG Qun;WU Yanxi;LI Longyu;ZHANG Yan;LIN Wenhua(Department of Cardiology,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院心内科,天津300457

出　　处：《实用心电学杂志》2023年第6期389-394,共6页Journal of Practical Electrocardiology

摘　　要：目的探讨伊伐布雷定对慢性心力衰竭患者QT间期和窦性心律的影响。方法选择179例慢性心力衰竭患者为研究对象,行12导联同步动态心电图检查,口服伊伐布雷定30~45 d后再次复查动态心电图,比较用药前后QT间期和心率的变化。结果143例患者完成临床随访,入选本研究。口服伊伐布雷定后,所有143例患者中最大QT间期[(467.9±62.6)ms vs.(473.6±63.4)ms]、最大QTc[(489.3±56.0)ms vs.(496.6±55.4)ms]、平均QT间期[(390.5±41.1)ms vs.(398.6±43.7)ms]、平均QTc[(417.2±31.4)ms vs.(414.4±36.9)ms]、最小QTc[(377.5±36.0)ms vs.(361.3±37.0)ms]与服药前比较,差异均有统计学意义(P<0.01);最小QT间期[(348.3±42.8)ms vs.(349.6±38.9)ms]服药前后比较,差异无统计学意义(P>0.05)。最慢心率[(50.3±8.6)次/min vs.(47.7±7.8)次/min]、平均心率[(69.9±11.7)次/min vs.(64.9±10.6)次/min]和最快心率[(116.6±23.1)次/min vs.(109.0±20.1)次/min]服药前后比较,差异均有统计学意义(P<0.01)。随访期间,无室性心律失常及猝死事件发生。结论伊伐布雷定可以明显缩短最大QT间期/QTc、平均QT间期并减慢心率,其临床应用安全有效。Objective To explore the effect of ivabradine on QT interval and sinus rhythm in patients with chronic heart failure(HF).Methods A total of 179 patients with chronic HF were selected as the research subjects.They underwent 12-lead synchronous ambulatory electrocardiography(AECG)examination,and reexamination of AECG 30-45 days after oral administration of ivabradine.The changes of QT interval and heart rate before and after medication were compared.Results A total of 143 patients complete clinical follow-up and are enrolled in this study.After oral administration of ivabradine,the maximum QT interval[(467.9±62.6)ms vs.(473.6±63.4)ms],the maximum QTc[(489.3±56.0)ms vs.(496.6±55.4)ms],the average QT interval[(390.5±41.1)ms vs.(398.6±43.7)ms],the average QTc[(417.2±31.4)ms vs.(414.4±36.9)ms],and the minimum QTc[(377.5±36.0)ms vs.(361.3±37.0)ms]of all the 143 patients are significantly different from those before medication(P<0.01).The minimum QT interval[(348.3±42.8)ms vs.(349.6±38.9)ms]does not vary significantly before and after medication(P>0.05).The differences of the minimum heart rate[(50.3±8.6)times per minute vs.(47.7±7.8)times per minute],the average heart rate[(69.9±11.7)times per minute vs.(64.9±10.6)times per minute],and the maximum heart rate[(116.6±23.1)times per minute vs.(109.0±20.1)times per minute]are all statistically significant before and after medication(P<0.01).During the follow-up period,there is no incidence of ventricular arrhythmia or sudden death.Conclusion Ivabradine could significantly shorten the maximum QT interval/QTc and the average QT interval,and slow down heart rate.Its clinical application is safe and effective.

关 键 词：心力衰竭 伊伐布雷定 QT间期 QTC 动态心电图 

分 类 号：R541.6[医药卫生—心血管疾病] R540.41[医药卫生—内科学]