何亚菲，林文华

临床研究

伊伐布雷定对慢性非缺血性心力衰竭患者心率变异性的影响

何亚菲，林文华

目的：观察在标准抗心力衰竭药物治疗基础上联合伊伐布雷定对慢性非缺血性心力衰竭患者心率变异性时域参数的影响。

方法：入选本院窦性心律的慢性非缺血性心力衰竭患者46例，根据2014年中国心力衰竭治疗指南使用伊伐布雷定。对入选患者在使用伊伐布雷定治疗前及治疗后8周分别行24 h动态心电图检查。

结果：在使用伊伐布雷定前，患者的心率变异性时域参数[平均RR间期、全部正常窦性心搏间期的标准差（SDNN）、RR间期平均值标准差（SDANN）、SDNN指数（SDNNindex）、相邻NN之差＞50 ms的个数占总窦性心搏个数的百分比（pNN50）、相邻RR间期差值的均方根（RMSSD）]均低于正常水平。使用伊伐布雷定治疗8周后，平均心率[（75.6±7.5）次/min vs（60.4±5.7）次/min，P＜0.01]、平均RR间期[（836.0±81.0）ms vs（1011.0±86.0）ms，P＜0.01]、SDNN[（61.6±14.8）ms vs（91.9±17.9）ms，P＜0.01]、SDANN[（52.3±15.2）ms vs（79.7±18.1）ms，P＜0.01]、SDNNindex[（24.3±7.1）ms vs（40.2±12.3）ms，P＜0.01]、pNN50[（2.7±1.6）ms vs（3.7±2.1）ms，P＜0.01]、RMSSD[（14.9±4.2）vs（19.1±4.9）ms，P＜0.001]均较治疗前显著改善。

结论：非缺血性心力衰竭患者使用伊伐布雷定能显著改善心率变异性。

心力衰竭；心率变异性；伊伐布雷定

Objective: To observe the impact of ivabradine combining standard anti-heart failure (HF) drug therapy in patients with non-ischemic HF for their time domain indices of heart rate variability (HRV).

Methods: A total of 46 patients with non-ischemic HF and sinus rhythmwere enrolled, ivabradine was used according to 2014 Chinese guidelines of HF treatment. 24h dynamic electrocardiogram recording was conducted before and 8 weeks after ivabradine therapy respectively.

Results: Before ivabradine treatment, the patients’ time domain indices of HRV were as follows: the mean RR interval, 24h standard deviation of all normal to normal RR intervals (SDNN), standard deviation of 5min mean RR intervals (SDANN), SDNNindex, percentage of successive normal RR intervals exceeding 50 ms (pNN50) and the mean square root of differences between successive normal to normal RR intervals (RMSSD) were all lower than normal levels. With 8 monthsivabradine treatment, the above indices were all improved as the following: the mean HR (75.6±7.5) bpm vs (60.4±5.7) bpm, mean RR interval (836.0±81.0) ms vs (1011.0±86.0) ms, SDNN (61.6±14.8) ms vs (91.9±17.9) ms, SDANN (52.3±15.2) ms vs (79.7±18.1) ms, SDNN index (24.3±7.1) ms vs (40.2±12.3) ms, pNN50 (2.7±1.6) ms vs (3.7±2.1) ms, all P＜0.01, and RMSSD (14.9±4.2) ms vs (19.1±4.9) ms, P＜0.001.

Conclusion: Ivabradine combining standard drug therapy may obviously improve HRV in patients with non-ischemic HF.

(Chinese Circulation Journal, 2016,31:1111.)

慢性心力衰竭是心血管领域的重要公共卫生问题，是巨大的医疗、社会、经济负担，严重影响患者的生活质量。慢性心力衰竭患者的预后差，7年病死率高达75%[1]。心率变异性（HRV）作为一种定量、无创、可重复的用于心血管自主神经功能测定的手段，研究发现，心率变异性时域参数全部正常窦性心搏间期的标准差（SDNN）每增加10 ms，心力衰竭患者的死亡风险下降20%[2]。心力衰竭治疗指南推荐联合伊伐布雷定治疗慢性心力衰竭[3]。伊伐布雷定是新型减慢心率的药物，是特异性心脏起搏电流（If）抑制剂，以剂量依赖性方式抑制If，降低窦房结节律，减慢心率，进而降低心肌耗氧量[4]。……