伊伐布雷定对缺血性心肌病患者心功能及心率变异性的影响

摘要

目的 探讨缺血性心肌病(ICM)患者在传统心力衰竭治疗基础上联合伊伐布雷定治疗对心功能和心率变异性(HRV)的影响.方法 入选85例ICM患者随机分为常规治疗组(n=42)和伊伐布雷定组(n=43).在常规缺血性心肌病治疗基础上,分别给予安慰剂和伊伐布雷定,观察记录两组患者治疗8周前后左室射血分数(LVEF)、NT-proBNP、SDNN、SDANN及RMSSD水平.结果 治疗8周后常规治疗组和伊伐布雷定组LVEF[(31.84±6.08)％比(28.12±5.33)％,P＜0.05;(37.73±7.60)％比(28.57±5.15)％,P＜0.05]及NT-proBNP[(2181.25±103.94)ng/L比(2372.61±125.87)ng/L,P＜0.05;(1673.43±114.70)ng/L比(2401.04±136.19)ng/L,P＜0.05]水平均较治疗前明显改善,且伊伐布雷定组患者LVEF[(37.73±7.60)％比(31.84±6.08)％,P＜0.05]及NT-proBNP[(1673.43± 114.70)ng/L比(2181.25±103.94)ng/L,P＜0.05]明显优于常规治疗组.治疗8周后常规治疗组患者SDNN、SDANN及RMSSD水平与治疗前比较未见统计学差异(P＞0.05),而伊伐布雷定组患者SDNN(92.89±17.42比64.09±12.03,P＜0.05)、SDANN(85.33±15.08比55.49±12.63,P＜0.05)及RMSSD(31.47±7.33比21.35±4.50,P＜0.05)水平与治疗前比较明显升高,且高于常规治疗组患者,差异有统计学意义(P＜0.05).结论 伊伐布雷定可进一步改善ICM患者心功能及HRV,值得临床推广.%Objective To investigate the effect of Ivabradine on cardiac function and heart rate variability (HRV) of ischemic cardiomyopathy (ICM) patients on the basic of conventional therapy.Methods A total of 85 patients diagnosed with ICM were enrolled and divided into conventional therapy group(receiving conventional antiatherosclerosis therapy and placebo,n=42) and Ivabradine group(receiving conventional anti-atherosclerosis therapy and Ivabradine,n=43).Left ventricular ejection fraction (LVEF),NT-proBNP,SDNN,SDANN,RMSSD were recorded and analyzed.Results The levels of LVEF[(31.84±6.08)％ vs (28.12±5.33)％,P＜0.05;(37.73±7.60)％ vs (28.57±5.15)％,P＜0.05] and NT-proBNP [(2181.25±103.94)ng/L vs (2372.61±125.87)ng/L,P＜0.05;1673.43±l14.70)ng/L vs (2401.04±136.19)ng/L,P＜0.05] were significantly improved after 8 weeks of treatment in both groups.The levels of LVEF [(37.73±7.60)％ vs (31.84±6.08)％,P＜0.05] and NT-proBNP [(1673.43 ± 114.70)ng/L vs (2181.25 ± 103.94)ng/L,P＜0.05] were significantly improved in Ivabradine group,compared to conventional therapy group after 8 weeks of treatment (P＜0.05).There was no statistical significance achieved of SDNN,SDANN and RMSSD in conventional therapy group before and after 8 weeks of treatment (P＞0.05).The levels of SDNN(92.89±17.42 vs 64.09±12.03,P＜0.05),SDANN (85.33±15.08 vs 55.49±12.63,P＜0.05) and RMSSD (31.47±7.33 vs 21.35±4.50,P＜0.05) of Ivabradine group were significantly increased after 8 weeks of treatment.And levels of SDNN,SDANN and RMSSD of Ivabradine group were significantly increased compared to those of conventional therapy group after 8 weeks of treatment (P＜0.05).Condusion Ivabradine has more pronounced effect for improving cardiac function and HRV,and it is worthy of clinical promotion.