伊伐布雷定对冠心病合并心律失常患者心率变异性的影响及对心房颤动的防治效果

doi:10.3969/j.issn.1000-8535.2023.12.014

摘要/Abstract

摘要： 目的观察伊伐布雷定对冠状动脉粥样硬化性心脏病（CHD,以下简称：冠心病）合并心律失常患者心率变异性（HRV）的影响,及对心房颤动（AF）的防治效果。方法本文为前瞻性研究,病例纳入时间为2021年1月—2023年1月,研究对象为焦作市第二人民医院收治的125例CHD合并心律失常患者,采用随机数字表法对入组患者进行分组,分别列为常规组（62例）和联合组（63例）,常规组予常规药物治疗,联合组在常规药物治疗基础上联合伊伐布雷定治疗,比较2组患者治疗前后的HRV指标、血管内皮功能指标、心功能指标改善情况、心房颤动发生率及用药安全性。结果治疗后,联合组24 h窦性心律RR间期标准差为（88.25±10.36）ms,24 h相邻正常RR间期差值均方根为（50.25±10.61）ms,24 h相邻正常RR间期差值>50 ms百分比为（12.04±3.41）%,均高于常规组[（81.44±10.77）ms、（43.28±10.71）ms、（10.77±3.08）%],组间比较差异具有统计学意义（P<0.05）。治疗后,联合组的血流介导下血管扩张程度为（12.33±3.27）%,硝酸甘油介导下血管内皮舒张程度为（9.83±2.21）%,均高于常规组[（10.25±3.23）%、（8.14±2.03）%]。AF发生率为4.76%（3/63）,低于常规组16.13%（10/62）,差异具有统计学意义（P<0.05）。治疗后,联合组的左室射血分数为（55.35±10.27）%,高于常规组（48.45±10.61）%,左室舒张末期内径为（40.24±10.37）mm,左室后壁厚度为（9.22±2.06）mm,均低于常规组[（46.33±10.28）mm、（10.88±2.46）mm],差异具有统计学意义（P<0.05）。治疗后,联合组的药物相关不良反应发生率为7.94%（5/63）,略高于常规组6.45%（4/62）,组间比较差异无统计学意义（P>0.05）。结论伊伐布雷定联合常规药物治疗CHD合并心律失常能有效改善患者HRV指标、血管内皮功能及心功能,降低AF发生率,且未增加药物不良反应发生风险。

关键词: 冠心病, 心律失常, 伊伐布雷定, 心率变异性, 心房颤动, 用药安全性

Abstract: Objective To observe the effect of ivabradine on heart rate variability（HRV）in coronary heart disease（CHD）patients with arrhythmia and its preventive and therapeutic effects on atrial fibrillation（AF）．Methods This is a prospective cohort study．The 125 CHD patients with arrhythmia were included from January 2021 to January 2023 and divided into the conventional group（62 cases）and the combined group（63 cases）by random number table．The conventional group was treated with conventional drugs,and the combined group was treated with ivabradine additionally．The HRV index,vascular endothelial function index,improvement of cardiac function indicators,incidence of AF and medication safety were compared．Results After treatment,the standard deviation of normal RR intervals in 24 h of the combination group was（88.25±10.36）ms,root mean square of successive RR interval differences in 24 h was（50.25±10.61）ms,and successive RR interval differences>50 ms was（12.04±3.41）%．Compared with the conventional group [（81.44±10.77）ms,（43.28±10.71）ms and（10.77±3.08）%],the above indicators were all higher（P<0.05）．After treatment,the flow-mediated dilation and nitrite-mediated dilation of the combination group were（12.33±3.27）% and（9.83±2.21）%,respectively．Compared with the conventional group（10.25±3.23）% and（8.14±2.03）%）,the above indicators were higher．The incidence of AF was 4.76%（3/63）,which was lower（P<0.05）than the conventional group of 16.13%（10/62）．After treatment,the left ventricular ejection fraction of the combination group was（55.35±10.27）%,which was higher than that of the conventional group（48.45±10.61）%．The left ventricular diastolic diameter was（40.24±10.37）mm and the left ventricular posterior wall thickness was（9.22±2.06）mm．Compared with the conventional group [（46.33±10.28）mm,（10.88±2.46）mm],the above indicators were all lower（P<0.05）．After treatment,the incidence of drug-related side effects in the combination group was 7.94%（5/63）,which was similar to 6.45%（4/62）in the conventional group（P>0.05）．Conclusions The combination of ivabradine and conventional drugs in the treatment of CHD complicated with arrhythmia can effectively improve HRV indicators in patients,promote the recovery of vascular endothelial cell function and cardiac function,reduce the incidence of AF,and do not significantly increase the risk of drug side effects．

Key words: coronary heart disease, arrhythmia, Ivabradine, heart rate variability, atrial fibrillation, drug safety

侯宇鹏. 伊伐布雷定对冠心病合并心律失常患者心率变异性的影响及对心房颤动的防治效果[J]. 广州医药, 2023, 54(12): 83-88.

HOU Yupeng. Effect of ivabradine on heart rate variability and prevention and treatment of atrial fibrillation in patients with arrhythmia in coronary heart disease[J]. Guangzhou Medical Journal, 2023, 54(12): 83-88.

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