周文杰 谢仁兵 罗正义

[摘要]目的采用伊伐布雷定對慢性心力衰竭患者进行严格心率管理，观察临床疗效。方法选取2019年1月至2020年8月在如皋市人民医院就诊的慢性心力衰竭患者102例，随机分为观察组（51例）和对照组（51例）。对照组服用美托洛尔采用宽松的心率管理方法，观察组在对照组基础上联合伊伐布雷定采用严格的心率管理方法。治疗12周后测定所有患者左室射血分数（LVEF）、氨基末端脑钠肽前体（NT-proBNP）、总体标准差（SDNN）、均值标准差（SDANN）、均方根（RMSSD）。结果治疗12周后观察组与对照组比较 LVEF 明显改善， NT-proBNP水平进一步降低，差异有统计学意义（ P <0.05）。治疗12周后观察组与对照组比较发现 SDNN、SDANN 和 RMSSD 水平进一步升高，差异有统计学意义（ P <0.05）。结论对于慢性心力衰竭患者联合使用伊伐布雷定和美托洛尔施行严格心率管理能够进一步改善心功能和心率变异性，值得临床推广。 [关键词]伊伐布雷定;慢性心力衰竭;心率管理; NT-proBNP

[中图分类号] R541.6  [文献标识码] A   [文章编号]2095-0616（2021）24-0181-04

Study on the clinical effect ofivabradine on strict heart rate management in patients with chronic heart failure

ZHOU  Wenjie    XIE  Renbing    LUO  Zhengyi

Department of Cardiology， the People's Hospital of Rugao， Jiangsu， Rugao 226500， China

[Abstract] Objective To adopt ivabradine to strictly manage the heart rate of patients with chronic heart failure （CHF）， and to observe the clinical efficacy. Methods A total of 102 CHF patients who were treated in the People's Hospital of Rugao from January 2019 to August 2020 were selected and randomly divided into the observation group （51 cases） and the control group （51 cases）. The control group took metoprolol with a loose heart rate management method， and the observation group received ivabradine on the basis of the same treatment in the control group with a strict heart rate management method. After 12 weeks of treatment， left ventricular ejection fraction （LVEF）， N-terminal pro- brain natriuretic peptide （NT-proBNP）， standard deviation of all normal-to-normal R-R intervals （SDNN）， standard deviation of 5-minute segments of normalized RR intervals （SDANN） and Root Mean Square of Successive Differences （RMSSD） were measured for all patients. Results After 12 weeks of treatment， the LVEF in the observation group significantly increased compared to that in the control group and the level of NT-proBNP further decreased， with statistically significant differences （P <0.05）. After 12 weeks of treatment， the levels of SDNN， SDANN and RMSSD in the observation group further increased compared to those in the control group， with statistically significant differences （P <0.05）. Conclusion For CHF patients the combined medication of ivabradine and metoprolol for strict heart rate management can further improve heart function and heart rate variability， and is worthy of clinical promotion.

[Key words] Ivabradine; Chronic heart failure; Heart rate management; NT-proBNP

慢性心力衰竭几乎是所有心血管疾病的终末状态，慢性心力衰竭患者具有活动耐量降低，反复住院，治疗费用昂贵等特点，使得其成为影响公众健康的重要因素之一[1]。在慢性心力衰竭的临床治疗中，除了常规的抗心力衰竭治疗外，控制心率治疗逐渐成为临床医师关注的焦点问题[2]。心力衰竭患者心率过快提示神经体液调节系统仍属于高负荷状态，近年来的大量临床研究表明，静息心率偏快是慢性心力衰竭患者临床不良事件发生的独立危险因素[3]。伊伐布雷定是一种新型的抗心力衰竭治疗药物，其独特的 If 通道阻滞作用给慢性心力衰竭患者带来了新的获益[4]。本研究采用伊伐布雷定联合传统的β受体阻滞剂严格控制慢性心力衰竭患者的静息心率，观察联合使用的临床疗效，为慢性心力衰竭患者的药物治疗提供新的思路，现报道如下。……