心率控制对慢性心力衰竭患者心功能的影响

摘要

Objective To investigate the effect of intensive heart rate control on cardiac function in patients with chronic heart failure .Methods From January 2015 to December 2015 ,a total of 120 CHF patients with New York Heart Association(NYHA) functional classes Ⅱ to Ⅳ were enrolled and randomized into treatment group(n=60) and control group( n =60) .All the patients were in stable situation after conventional drug treatment .The patients in treatment group underwent intensive heart rate control for target HR (55-60bpm) through adjusting the dose of metoprolol sustained-release tablets .The resting heart rate ,the concentration of brain natriuretic peptide (BNP) ,left ventricular ejection fraction (LVEF) ,left ventricular end diastolic diameter (LVEDD) ,left ventricular end systolic dimension(LVEDD) and 6-minute walking test distance were measured at the start and 12-months af-ter treatment .The primary outcome endpoint was hospitalization resulting from worsening HF.Results After 12-months treatment ,the resting heart rate of the patients in the treatment group decreased significantly compared with that of control group( P<0 .01) ,the echocardiography parameters (LVEDD ,LVESD) and the concentration of BNP of the patients in the treatment group decreased significantly ( P <0 .05) ,6-minute walking test distance and LVEF of treatment group increased significantly ( P <0.05) .There was a significant difference in the incidence of hospital admission for worsening heart failure between two groups during 12-month follow-up( P<0.05).Conclusion Intensive heart rate control in patients with chronic heart failure can significantly improve the cardiac function .%目的 观察慢性心力衰竭患者入院后予以积极控制心率后对心功能的影响.方法 选择2015年1月至12月在上海市浦东医院心血管内科住院纽约心脏学会(N Y H A)心功能分级Ⅱ ～ Ⅳ级的120例充血性心力衰竭(CHF)患者,随机数字表法分配至治疗组及对照组,所有患者在常规治疗基础上,治疗组予以琥珀酸美托洛尔缓释片积极控制心率,以患者静息心率降至55～60次/min为目标心率指导药物治疗.检测2组治疗前、治疗12个月后静息心率,左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD),左心室射血分数,6 min步行试验距离以及血清脑钠肽(BNP)水平,以心力衰竭再入院为终点事件.结果 治疗12个月后,治疗组患者静息心率显著低于对照组(P<0.01),治疗组患者LVEDD、LVESD及血浆BNP水平显著低于对照组,6 min步行试验距离、LVEF显著高于对照组(P<0.05),心衰再入院率低于对照组(P<0.05).结论 积极控制心率可以改善CHF患者心功能.