β受体阻滞剂治疗心力衰竭合并房颤患者的疗效及安全性
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摘要
目的探讨β受体阻滞剂治疗心力衰竭合并房颤患者的疗效及安全性。方法选取80例心力衰竭合并房颤患者随机分为2组,传统组采用传统治疗,β受体阻滞剂组则加用β受体阻滞剂,比较2组患者疾病相关指标、总体治疗效果、心功能Ⅰ～Ⅱ级率、生活质量与安全性。结果治疗后,β受体阻滞剂组患者静息心率、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、B型脑钠肽(BNP)、最大P波时限(Pmax)与P波离散度(Pd)水平均显著低于传统组(P <0. 01),左心室射血分数(LVEF)与6 min步行距离(6MWD)均显著高于传统组(P <0. 01);β受体阻滞剂组患者治疗后的生活质量整体得分显著低于传统组(P <0. 01);β受体阻滞剂组总有效率与治疗后心功能Ⅰ～Ⅱ级率显著高于传统组(P <0. 05); 2组药物不良反应率差异无统计学意义(P> 0. 05)。结论β受体阻滞剂治疗心力衰竭合并房颤患者的疗效显著,安全性较高。
Objective To investigate the efficacy and safety of β-blocker in the treatment of patients with heart failure and atrial fibrillation Methods A total of 80 patients with heart failure and atrial fibrillation admitted to hospital were randomly divided into two groups. The patients in the traditional group were treated with traditional therapy and those in the β-blocker group were treated withβ-receptor blocker defibrillators. Disease-related indicators,the overall treatment efficacy,Ⅰ ～ Ⅱgrade rate of heart function,quality of life and safety of the two groups were compared. Results After treatment,the resting heart rate,left ventricular end diastolic volume( LVEDV),left ventricular end systolic volume( LVESV),B-type natriuretic peptide( BNP),maximum P-wave duration( Pmax)and P-wave dispersion( Pd) levels in the β-blocker group were significantly lower than those in the traditional group( P < 0. 01); left ventricular ejection fraction( LVEF) and 6 min walk distance( 6MWD) after treatment were significantly higher than those in the traditional group( P < 0. 01).The β-blocker group had lower total quality of life score,higher the total effective rate and the cardiac function with grade Ⅰ ～ Ⅱ after treatment than the traditional group( P < 0. 05). There was no significant difference in drug adverse reaction between the two groups( P > 0. 05). Conclusion The β-blocker in the treatment of patients with heart failure and atrial fibrillation has significant efficacy,and it is safer in clinic application.
Objective To investigate the efficacy and safety of β-blocker in the treatment of patients with heart failure and atrial fibrillation Methods A total of 80 patients with heart failure and atrial fibrillation admitted to hospital were randomly divided into two groups. The patients in the traditional group were treated with traditional therapy and those in the β-blocker group were treated withβ-receptor blocker defibrillators. Disease-related indicators,the overall treatment efficacy,Ⅰ ～ Ⅱgrade rate of heart function,quality of life and safety of the two groups were compared. Results After treatment,the resting heart rate,left ventricular end diastolic volume( LVEDV),left ventricular end systolic volume( LVESV),B-type natriuretic peptide( BNP),maximum P-wave duration( Pmax)and P-wave dispersion( Pd) levels in the β-blocker group were significantly lower than those in the traditional group( P < 0. 01); left ventricular ejection fraction( LVEF) and 6 min walk distance( 6MWD) after treatment were significantly higher than those in the traditional group( P < 0. 01).The β-blocker group had lower total quality of life score,higher the total effective rate and the cardiac function with grade Ⅰ ～ Ⅱ after treatment than the traditional group( P < 0. 05). There was no significant difference in drug adverse reaction between the two groups( P > 0. 05). Conclusion The β-blocker in the treatment of patients with heart failure and atrial fibrillation has significant efficacy,and it is safer in clinic application.
引文
[1]王婧,王敬萍,王慧仙,等.β1及β3肾上腺素受体自身抗体在缺血性心肌病心衰中的临床研究[J].中国心血管病研究,2016,14(6):532-536.
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[12]王冬梅,于海波,齐书英,等.影响心力衰竭伴永久性心房颤动再同步治疗的相关因素分析[J].中华心血管病杂志,2012,40(9):757-761.
[13]宋月祥.β受体阻滞剂治疗慢性心力衰竭并快速型房颤的疗效观察[J].中国医药导刊,2013,15(1):127-128.
[14]李日行,林桂花,方凌燕,等.慢性心房颤动伴心功能不全病人使用β受体阻滞剂的临床观察[J].中西医结合心脑血管病杂志,2016,14(4):404-406.
[15]赵晓川,赵昕,杨晓旭,等.监测NT-ProBNP水平指导β受体阻滞剂治疗危重冠心病心力衰竭患者疗效观察[J].临床军医杂志,2016,44(5):495-499.
[16]李海燕,王永春,牛慧,等.β受体阻滞剂联合曲美他嗪治疗缺血性心力衰竭对BNP、CysC水平及预后的影响[J].现代中西医结合杂志,2017,26(31):3519-3521.
[17]邓伏雪,王小娟,胡云凤,等.急性心肌梗死并发首次心力衰竭患者在院死亡率及临床预后分析[J].西安交通大学学报:医学版,2015,36(1):135-140.
[18]刘静,刘恒亮,白树鸣,等.缺血性心脏病合并心力衰竭患者冠脉病变特点[J].实用医学杂志,2017,33(20):3424-3428.
[19]韦耀.美托洛尔联合曲美他嗪治疗冠心病心力衰竭的临床疗效分析[J].实用临床医药杂志,2017,21(15):183-184.
[20] Abi Khalil C,Sulaiman K,Mahfoud Z,et al. Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East[J]. BMJ Open,2017,7(7):e014915.
[2]杨坤,潘波,代静澜,等. NT-proBNP指导中重度心力衰竭患者β1受体阻滞剂使用的临床研究[J].重庆医学,2015,44(24):3355-3356,3359.
[3]曾庆华,王林,喻蓉,等.β受体阻滞剂对永久起搏器植入患者左室收缩功能的影响[J].西部医学,2011,23(12):2347-2348.
[4] Puymirat E,Riant E,Aissaoui N,et al.βblockers and mortality after myocardial infarction in patients without heart failure:multicentre prospective cohort study[J]. BMJ,2016,354:i4801.
[5]夏云龙,张荣峰,杨延宗.规范抗凝宽松控制心室率:2011年ACCF/AHA/HRS心房颤动治疗指南更新解读[J].中国循环杂志,2012,27(z1):44-47.
[6]种甲.再灌注时代β受体阻滞剂在急性心肌梗死防治中的地位再评价[J].中国心血管杂志,2014,19(4):310-313.
[7]李江津,田晓沂,杨静,等.监测血浆BNP对中、重度心衰患者合理应用β1受体阻滞剂的指导价值[J].江苏医药,2011,37(14):1680-1682.
[8] Fukuta H,Goto T,Wakami K,et al. The effect of betablockers on mortality in heart failure with preserved ejection fraction:A meta-analysis of observational cohort and randomized controlled studies[J]. Int J Cardiol,2017,228:4-10.
[9] Alegría J,Rada G. Are beta-blockers effective in heart failure with preserved ejection fraction?[J]. Medwave,2016,16(Suppl5):e6593.
[10]张娜.β-受体阻滞剂治疗心力衰竭对心功能及生存质量的影响[J].陕西医学杂志,2017,46(1):99-100,111.
[11]周长文,罗素新.β受体阻滞剂在慢性心力衰竭中的临床应用[J].重庆医学,2014,43(17):2226-2228.
[12]王冬梅,于海波,齐书英,等.影响心力衰竭伴永久性心房颤动再同步治疗的相关因素分析[J].中华心血管病杂志,2012,40(9):757-761.
[13]宋月祥.β受体阻滞剂治疗慢性心力衰竭并快速型房颤的疗效观察[J].中国医药导刊,2013,15(1):127-128.
[14]李日行,林桂花,方凌燕,等.慢性心房颤动伴心功能不全病人使用β受体阻滞剂的临床观察[J].中西医结合心脑血管病杂志,2016,14(4):404-406.
[15]赵晓川,赵昕,杨晓旭,等.监测NT-ProBNP水平指导β受体阻滞剂治疗危重冠心病心力衰竭患者疗效观察[J].临床军医杂志,2016,44(5):495-499.
[16]李海燕,王永春,牛慧,等.β受体阻滞剂联合曲美他嗪治疗缺血性心力衰竭对BNP、CysC水平及预后的影响[J].现代中西医结合杂志,2017,26(31):3519-3521.
[17]邓伏雪,王小娟,胡云凤,等.急性心肌梗死并发首次心力衰竭患者在院死亡率及临床预后分析[J].西安交通大学学报:医学版,2015,36(1):135-140.
[18]刘静,刘恒亮,白树鸣,等.缺血性心脏病合并心力衰竭患者冠脉病变特点[J].实用医学杂志,2017,33(20):3424-3428.
[19]韦耀.美托洛尔联合曲美他嗪治疗冠心病心力衰竭的临床疗效分析[J].实用临床医药杂志,2017,21(15):183-184.
[20] Abi Khalil C,Sulaiman K,Mahfoud Z,et al. Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East[J]. BMJ Open,2017,7(7):e014915.