最优心率方法在二尖瓣狭窄并心房颤动患者心率控制中的导向作用

摘要

目的　评价最优心率(Rapp)方法指导二尖瓣狭窄（MS）并心房颤动（AF）患者控制心率以改善心脏泵功能的可行性和作用。方法　以Rapp系列公式个体化地设定心率控制目标，并通过心率调节方法使心率接近Rapp，比较心率调节治疗前后临床及血流动力学变化。结果　所有病例接受心率调节治疗且无技术障碍，本组患者Rapp为（76.5±7.6）次/min,分布范围为 58.7～98.7次/min，经心率调节治疗后临床状况及心脏泵功能改善。结论　按Rapp方法调节心率切实可行，MS并AF患者心率控制目标应个体化，该方法为引导临床个体化控制心率改善心功能提供了新方法。%Objective　To assess the feasibility and efficiency of the appropriate ventricular rate (Rapp) method in guiding ventricular rate regulation by Doppler echocardiographic parameters.Methods　Doppler echocardiographic parameters were measured in 37 MS patients with AF.Improving globe function of heart by compromise of ventricular rate and left ventricular filling volume, the target of heart rate regulation was set up individually according to Rapp formula and method. Ventricular rate was regulated carefully toward Rapp by using digoxin, betaloc or atropine, and the hemodynamics parameters were compared after ventricular rates were regulated for 1 to 3 weeks.Results　The Rapp was (76.5±7.6)b/min in the studied group and distribution was 58.7～98.7 b/min. The Rapp in moderate MS was higher than that in severe MS ［(84.3±6.2)b/min vs (73.6±8.5)b/min,P<0.0001］. Clinical condition and globe function of heart were improved after regulating ventricular rate toward Rapp.Conclusions　The mean Rapp in the studied group is close to the aim of ventricular rate regulation in clinical practice,but it is emphasized that ventricular rate would be controlled individually. Cardiac output can be improved obviously by regulating ventricular rate toward Rapp in patients of MS with AF.