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

来源期刊：广州医药 | 83-88 发布时间：2024-01-10 收稿时间：2025/11/13 18:28:30 阅读量：55

作者：: 侯宇鹏,

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; coronary heart disease arrhythmia Ivabradine heart rate variability atrial fibrillation drug safety

DOI：: 10.3969/j.issn.1000-8535.2023.12.014

收稿时间：: 2023-07-05
修订日期：
接收日期：
引用总数：: 3

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。

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．

1、陈洪云. 盐酸伊伐布雷定对高龄老年冠心病合并心功能不全患者心率及心功能的影响[J].中国医药指南,2021,19(8):26-27.

2、杨温藤,林小君,郑毅.伊伐布雷定治疗慢性心力衰竭的临床疗效及对血流动力学、血管内皮功能、炎性因子的影响[J].中国卫生检验杂志,2019,29(3):337-340,350.

3、 IDE T,OHTANI K,HIGO T,et al.Ivabradine for the treatment of cardiovascular diseases[J].Circ J,2019,83(2):252-260.

4、中国医师协会心力衰竭专业委员会,国家心血管病专家委员会心力衰竭专业委员会,中华心力衰竭和心肌病杂志编辑委员.伊伐布雷定临床应用中国专家共识[J].中华心力衰竭和心肌病杂志,2020,4(2):84-91.

5、尹琪楠,韩丽珠,边原,等.伊伐布雷定用于心律失常的研究进展[J].医药导报,2023,42(4):515-519.

6、何瑞,杨绍青,李爱娟,等.β-受体阻滞剂对老年冠心病慢性心力衰竭患者运动耐量及生存质量的影响[J].中国临床康复,2002,6(19):2937-2938.

7、樊小俊. β受体阻滞剂在治疗心血管疾病方面的应用现状研究[J].当代医药论丛,2020,18(7):135-136.

8、田玉静,邸杰.通脉养心丸联合β受体阻断剂治疗冠心病心律失常效果研究[J].河北医药,2021,43(1):71-73,77.

9、柯居中,吴抗,刘晓琳,等.上海市浦东新区队列人群危险因素与冠心病发病的关联性分析[J].中国医药导报,2021,18(20):46-50.

10、中华医学会心血管病学分会,中国生物医学工程学会心律分会.心房颤动诊断和治疗中国指南[J].中华心血管病杂志,2023,51(6):572-618.

11、杨雪佳,胡靖,张媛媛,等.盐酸法舒地尔对PCI术后慢血流冠心病患者内皮细胞损伤的作用及其机制研究[J].中国现代医学杂志,2020,30(13):31-36.

12、中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.稳定性冠心病基层诊疗指南(实践版·2020)[J].中华全科医师杂志,2021,20(3):274-280.

13、 RITT L E F,RIBEIRO R S,SOUZA I P M A,et al.Low concordance between NYHA classification and cardiopulmonary exercise test variables in patients with heart failure and reduced ejection fraction[J].Arq Bras Cardiol,2022 ,118(6):1118-1123.

14、肖蕾,孙晓臣,罗溶.动态心电图在冠心病心肌缺血与心律失常诊断中的价值分析[J].解放军医药杂志,2022,34(1):61-64.

15、刘雯. 伊伐布雷定片对冠心病患者心功能、血液流变学及氧化应激反应的影响[J].实用中西医结合临床,2022,22(3):14-16,23.

16、谢晓莉,王山斌,王玉静,等.不同治疗方法对冠心病患者心率变异性血清KLK1 TIMP-1水平及近期预后的影响研究[J].河北医学,2023,29(4):652-657.

17、关雪冰. 胺碘酮联合美托洛尔治疗冠心病合并心律失常的疗效分析[J].中国冶金工业医学杂志,2021,38(2):187-188.

18、白净. 药物治疗冠心病合并心律失常的临床疗效分析[J].中外医疗,2022,41(14):116-120.

19、 SARKAR G,GAIKWAD V B,SHARMA A,et al.Fixed-dose combination of metoprolol,telmisartan,and chlorthalidone for essential hypertension in adults with stable coronary artery disease:Phase III Study[J].Adv Ther,2022,39(2):923-942.

20、武献红,时晓洁,刘柯君.阜阳市心血管疾病高危人群冠心病患病现状调查[J].华南预防医学,2021,47(9):1185-1187.

1、李鑫琪.新加芦黄颗粒治疗稳定性冠心病（气阴两虚、瘀热互结证）的临床疗效及其对血清IL-6、NO、S1P水平影响的研究[D].南京中医药大学,2024.DOI:10.27253/d.cnki.gnjzu.2024.000680.

2、文立蓉,段雪玉,吴广俊,等.基于FAERS数据库的美托洛尔不良事件信号挖掘[J].广州医药,2025,56(01):106-112.DOI:10.20223/j.cnki.1000-8535.2025.01.015.

3、叶懿萱,刁晓艳.伊伐布雷定对COPD合并HFpEF患者疗效及预后的影响[J].中国医药导刊,2025,27(01):76-81.