史新霞 鹿璐 鹿彦红

[摘要] 目的 探討芪苈强心胶囊联合伊伐布雷定治疗缺血性心肌病（ICM）的效果。 方法 选择2016年6月—2019年6月于山东省新泰市中医医院就诊的70例ICM患者，按随机数字表法将其分为对照组和观察组，各35例。两组给予常规治疗，在此基础上对照组给予芪苈强心胶囊治疗，观察组给予芪苈强心胶囊联合伊伐布雷定治疗。比较两组的临床疗效，观察治疗前后左心功能[峰射血率（PER）、峰充盈率（PFR）、左心室射血分数（LVEF）及左室短轴缩短率（LVSF）]、自主神经功能[全程全部NN间期标准差（SDNN）、24 h内每5分钟NN间期均值的标准差（SDANN）、全程相邻NN间期之差的均方根值（rMSSD）、相邻RR间期相差≥50 ms的百分数（pNN50）、低频功率/高频功率（LF/HF）]、相关神经内分泌因子[N末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（cTnI）]及心肌酶[肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）]水平的变化。 结果 观察组总有效率明显高于对照组（P < 0.05）;治疗后两组PER、PFR、LVEF及LVSF均较治疗前升高（P < 0.05），其中观察组治疗后LVEF及LVSF均高于对照组（P < 0.05）; 治疗后两组NT-proBNP、cTnI及CK、CK-MB水平均较治疗前显著降低，且观察组低于对照组（P < 0.05）;与治疗前比较，两组SDNN均显著增加，观察组SDANN显著增加（P < 0.05），观察组治疗后SDNN及SDANN高于对照组（P < 0.05）。两组不良反应发生率比较差异无统计学意义（P > 0.05）。 结论 芪苈强心胶囊联合伊伐布雷定治疗ICM效果确切，可改善左心功能，调节自主神经功能，不良反应较低，值得临床推广。

[关键词] 芪苈强心胶囊;伊伐布雷定;缺血性心肌病;临床疗效;自主神经功能

[中图分类号] R542.2          [文献标识码] A          [文章编号] 1673-7210（2020）08（b）-0045-04

[Abstract] Objective To explore the effect of Qili Qiangxin Capsules combined with Ivabradine in the treatment of ischemic cardiomyopathy （ICM）. Methods Seventy ICM patients treated in Xintai Hospital of Traditional Chinese Medicine from June 2016 to June 2019 were selected and divided into control group and observation group according to random number table method， with 35 cases in each group. The two groups were given conventional treatment， on basis of which， the control group was given Qili Qiangxin Capsules and the observation group was given Qili Qiangxin Capsules combined with Ivabradine. The clinical effects of the two groups were compared and the changes of left heart function [peak ejection rate （PER）， peak filling rate （PFR）， left ventricular ejection fraction （LVEF） and left ventricular shortening fractional （LVSF）]， autonomic nerve function [standard deviation of NN intervals （SDNN）， standard deviation average of NN intervals （SDANN）， root mean square of successive differences （rMSSD） of adjacent RR intervals， the proportion of successive RR intervals difference≥50 ms in percentage （pNN50）， low-frequency/high-frequency （LF/HF）]， related neuroendocrine factors [N-terminal pro-brain natriuretic peptide （NT-proBNP）， cardiac troponin I （cTnI），] and myocardial enzymes [creatine kinase （CK）， creatine kinase-MB （CK-MB）] were observed before and after treatment. Results The total effective rate in observation group was significantly higher than that in control group （P < 0.05）. After treatment， PER， PFR， LVEF and LVSF in both groups were higher than those before treatment （P < 0.05）. After treatment， LVEF and LVSF in observation group were higher than those in control group （P < 0.05）. After treatment， the levels of NT-proBNP， cTnI， CK and CK-MB in both groups were lower than those before treatment， and observation group were lower than those in control group （P < 0.05）. Compared with those before treatment， SDNN were increased in both groups， SDANN in observation group was significantly increased （P < 0.05）. After treatment， SDNN and SDANN in observation group were higher than those in control group （P < 0.05）. There was no significant difference in the incidence of adverse reactions between two groups （P > 0.05）. Conclusion Qili Qiangxin Capsules combined with Ivabradine is effective in the treatment of ICM， which can improve left heart function， regulate autonomic nerve function， adverse reaction is lower， and it is worthy of clinical promotion.

[Key words] Qili Qiangxin Capsules; Ivabradine; Ischemic cardiomyopathy; Clinical effect; Autonomic nerve function

缺血性心肌病（ICM）属于特异性心肌病，表现为左心室或左、右心室扩张及收缩功能受损[1]。ICM患者常伴有交感神经异常兴奋及心功能不全，因此控制心率是其治疗的基石[2]。临床上常见的调控心率药为β受体拮抗剂，其结构与儿茶酚胺相似，能选择性地与β受体结合，从而降低血压，减慢心律。然而β受体阻滞剂也存在诸多禁忌证，严重的支气管哮喘、中重度房室传导阻滞、急性心力衰竭等限制了其临床应用，心率快慢取决于窦房结细胞4期自动去极化的速度。……