伊伐布雷定治疗慢性阻塞性肺疾病合并心力衰竭患者的疗效观察

摘要

目的观察慢性阻塞性肺疾病(COPD)合并心力衰竭(HF)患者使用伊伐布雷定的有效性和安全性.方法连续入选2016年8月～2017年2月于空军军医大学唐都医院门诊及住院治疗的慢性阻塞性肺疾病合并心力衰竭患者62例,随机分为治疗组32例及对照组30例,治疗组患者在标准心衰治疗基础上,联用伊伐布雷定,而对照组仅给予标准心衰治疗.连续用药3个月,记录两组患者用药前后静息心率,N末端脑钠肽前体(NT-proBNP)水平、6 min步行试验距离和左心室射血分数(LVEF),同时随访患者3个月时间内出现的临床不良事件.结果治疗组及对照组患者基线资料无统计学差异.治疗3个月后,治疗组患者静息心率显著低于对照组(62.3±1.8 vs.77.3±2.1)次/min,(P＜0.05),治疗组患者的LVEF及6 min步行试验距离均显著高于对照组,而NT-proBNP水平则低于对照组(P均＜0.05).治疗组患者的平均住院时间显著低于对照组(8.5±1.7 vs.10.2±2.1)d,(P＜0.05),而两组患者3个月时间内临床不良事件的发生率无统计学差异(P＞0.05).结论对于慢性阻塞性肺疾病合并心力衰竭患者,伊伐布雷定可以有效控制静息心率,进一步改善患者心脏功能.%Objective To observe the effectiveness and safety of ivabradine in patients with chronic obstructive pulmonary disease (COPD) complicated by heart failure.Methods The patients (n=62) were chosen continuously from Outpatient Department or Inpatient Department in Tangdu Hospital of Fourth Military Medical University from Aug.2016 to Feb.2017, and divided randomly into treatment group (n=32) and control group (n=30).The treatment group was given ivabradine on the base of standard therapy of heart failure, and control group was only given standard therapy of heart failure.After continuous treatment for 3 months, resting heart rate, level of N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk test (6MWT) and left ventricular ejection fraction (LVEF) were recorded in 2 groups, and clinical adverse events were followed up within 3 months.Results The baseline data had no statistical difference between 2 groups.After treatment for 3 months, resting heart rate was significantly lower (62.3±1.8 vs.77.3±2.1, P＜0.05), LVEF and 6MWT were significantly higher, and level of NT-proBNP was lower in treatment group than those in control group (all P＜0.05).The mean length of hospital stay was significantly lower in treatment than that in control group (8.5±1.7 d vs.10.2±2.1 d, P＜0.05), and incidence of clinical adverse events had no statistical difference between 2 groups within 3 months (P＞0.05).Conclusion Ivabradine can effectively control resting heart rate and further improve heart function in patients with COPD complicated by heart failure.