曲美他嗪对老老年慢性心力衰竭患者自主神经功能干预的配对交叉研究

摘要

目的 研究曲美他嗪对常规治疗的老老年(年龄＞80岁)慢性心力衰竭患者心率变异性的影响,用以明确曲美他嗪在老老年心功能较差的患者是否能改善受损的自主神经功能.方法 选择慢性心力衰竭老老年患者20对,其中男性12对,女性8对.纳入标准依据Framingham心力衰竭诊断标准,剔除含有中途退出试验的对于.病例采用两处理二阶段配对交叉设计,将符合纳入标准的病例按配对条件进行配对,再用随机分配的方法将其中之-(A组)先采用A处理方式(服用曲美他嗪20mg,每日3次),再用B处理方式(不服用曲美他嗪),另一研克对象(B组)则先用B处理方式再用A处理方式,健这两种处理方式在研究过程中交叉进行,患者单盲.分别在试验开始前、第2周末、第5用末进行动态心电图检查,结束试验.观察指标为心率变异性参数:24小时全部正常窭性R-R间期标准差(SDNN)；24小时内每5分钟时间段窭性R-R间期平均值的标准差(SDANN)；24小时全部正常窭性R-R间期差值的均方根(rMSSD)；心率变异三角指数(HRVTI).结果 A组的心率变异性增加具有纯计学意义(F SDNN=226.024,F SDANN＝57.654,F rMSSD＝2 735.080,F HRVTI=85.462)( P＜0.05或＜0.01).结论 除常规治疗外,应用曲美他嗪治疗老老年慢性心力衰竭,能显著提高患者的心率变异性,改善自主神经功能,具有不依赖于其他改善血流动力学药物的显著正性作用,改善心肌细胞代谢可能是此方面作用的主要基础.%Objective To explore the effects of trimetazidine(TMZ) on the heart rate variability(HRV) andinjured function of autonomic nerves in elderly patients (age>80 years) with chronic heart failure. Methods Totally 40 cases (20 pairs) of eideriy patients with chronic heart failure were studied. The inclusive criteria were under the Framingham Heart Failure Diagnosis Standard,excluding the patients not finishing study. The study was randomized, pair-matched,crossover and single-blinded clinic study. First, according to the limitations, the patients were matched into pairs,then randomed to group A or group B. The patients in group A were treated with TMZ except for routine therapy, while the patients in group B received routine therapy without TMZ. After two weeks of treatment and one week of washout period, the patients in pairs were crossed over each other (the two methods/treatments). 24 hour electrocardiogram monitoring examination was taken at the beginning, again after two-weeks of treatment and five-weeks of treatment. Values of HRV included standard deviation of all normal sinus R-R intervals over 24 hours (SDNN); standard deviation of the averaged normal sinus R-R intervals for all 5-minute segments over 24 hours (SDANN) ;root mean square of the successive normal sinus R-R intervals difference over 24 hours(Rmssd) and HRV triangular index(HRVTI). Results Values of HRV were significantly increased after treatment with TMZ, F sdnn = 226.024, Fsoann = 57. 654, F ,mssd= 2 735.080, F hrvti = 85. 462 ( P <0.05 or <0.01). Conclusion Besides the routine treatment, TMZ may play some important and remarkably positive roles in the improvement of HRV and autonomic nervous function in elderly patients with chronic heart failure, TMZ is not dependent on the other haemodynamic changes,which is the main cause to improve energy metabolism of myocardial cells,