伊伐布雷定对血压偏低患者临床疗效及安全性观察

摘要

目的探究伊伐布雷定对血压偏低的慢性充血性心力衰竭、快速房性心律失常及窦性心动过速患者临床疗效及安全性.方法连续入选2017年8月～2018年4月就诊于陆军总医院心内科门诊的患者52例,其中慢性充血性心力衰竭18例,持续性或阵发性快速房颤19例,快速房扑1例,单纯窦性心动过速14例,所有患者平素基础血压＜120/80 mmHg.随机分为观察组和对照组,在原来基础治疗基础上,观察组予以伊伐布雷定治疗,起始剂量5 mg/次,2/d,最大剂量7.5 mg/次;对照组予以酒石酸美托洛尔,起始剂量6.25 mg/次,2/d,能耐受情况下逐渐增加剂量.观察对比两组患者心率、血压、心功能等情况.结果经8周治疗后,观察组患者静息心率下降明显优于对照组(P＜0.05),心衰患者心功能改善也优于对照组(P＜0.05),且对血压没有明显影响,头晕、乏力等不良反应明显少于对照组(P＜0.05).结论对于血压偏低的快速心律失常患者,伊伐布雷定降低静息心率,疗效、耐受性和安全性明显好于β受体阻滞剂.%Objective To study the clinical efficacy and safety of ivabradine hydrochloride in patients with congestive heart failure (CHF), rapid atrial tachyarrhythmia and nodal tachycardia with low blood pressure.Methods The patients (n=52), among them 18 with CHF, 19 with sustained or paroxysmal rapid atrial tachyarrhythmia, 1 with atrial flutter and 14 with nodal tachycardia, were chosen from Department of Cardiology of Chinese PLA Army General Hospital from Aug.2017 to Apr.2018.The usually basic blood pressure was higher than 120/80 mmHg in all patients.The patients were randomly divided into observation group and control group, and besides of basic treatment the observation group was given ivabradine hydrochloride in initial dose of 6.25mg/time, twice a day and the highest dose was 7.5 mg/time.The control group was given metoprolol tartrate in initial dose of 6.25 mg/time, twice a day and the dose was gradually increased to tolerable dose.The changes of heart rate (HR), blood pressure (BP) and heart function were observed and compared in 2 groups.Results After treatment for 8 weeks, resting HR was significantly lower in observation group than that in control group (P＜0.05).The improvement of heart function was better in observation group than that in control group (P＜0.05), and BP was no effected significantly.The adverse reactions, including dizziness and weak, were significantly less in observation group than those in control group (P＜0.05).Conclusion Ivabradine hydrochloride can reduce resting HR, and its curative effect, tolerance and safety are higher than those ofβ-receptor blocker in patients with tachyarrhythmia with low blood pressure.