卡维地洛对慢性肾功能不全患者QT离散度和心率变异性的影响

摘要

目的 探讨卡维地洛对慢性肾功能不全(CRI)患者QT离散度(QTd)和心率变异性(HRV)的影响.方法 将40例诊断CRI而未经透析治疗的患者随机分为治疗组和对照组各20例,治疗组在常规治疗的基础上加用卡维地洛,初始剂量5 mg,2次/d,每2周增加1倍剂量,直至20 mg,2次/d或最大耐受量为止.对照组使用硝苯地平控释片替代卡维地洛.采用24h动态心电图分析和记录治疗前后心率、QTd、HRV的变化.结果 治疗组用卡维地洛治疗6个月后,心率下降、QTd明显缩短(P＜0.05)、心率变异性参数改善(P＜0.01).两组间比较,治疗组的SDNN、HF值提高更明显(P＜0.01);LF/HF值显著降低(P＜0.01),对照组降低不明显(P＞0.05).结论 卡维地洛治疗CRF患者,可缩小QTd,使心肌复极趋向同步,提升HRV,改善自主神经功能.%Objective To investigate the effect of carvediol on changes of QT dispersion and heart rate variability in the patients with chronic renal insufficiency. Methods Forty patients with chronic renal insufficiency under conventional therapy were randomly divided into the carvediol group (n=20) and the control group (n=20). Patients in the carvediol group were given carvediol based on the conventional therapy, with initial dosage of 5 mg B.i.d, doubled every two weeks till the target dosage of 20 mg B.i.d or maximal tolerance dosage. Patients in the control group were given Nifedipine Controlled-Release Tablets based on the conventional therap. The changes of QT dispersion, heart rate variability were observed before and after treatment in the two groups by 24-hour ambulatory ECG. Results Six months after treatment, the decline of heart rate and QT dispersion, and the improvement in the index of heart rate variability were significantly more profound in the carvediol group than the control group (P<0.05 or P<0.01). The increase in standard deviation of normal to normal intervals (SDNN) and the High frequency (HF), and the decrease in LF/HF were significantly more profound in the carvediol group than the control group (PO.05 or P<0.01). Conclusion Carvediol can improve heart rate variability and changes of QT dispersion in patients with chronic renal insufficiency.