摘要
目的通过观察心率变异性(HRV)指标、心功能指标及生化指标变化,探讨螺内酯对扩张型心肌病心衰患者心率变异性、心室重构的影响以及用药的安全性。方法选择扩张型心肌病心衰患者67例,分为常规治疗组(32例)和螺内酯组(35例),视液体潴留及血钾浓度情况加用呋噻米及补钾治疗。治疗前1天及治疗3个月后分别检测心率变异性及各项心功能指标。结果两组基线参数无统计学差异。治疗后两组HRV的时域指标SDNN、SDANN、rMSSD及频域指标较治疗前均明显改善,螺内酯组改善更为显著(p<0.05),SDANN、rMSSD的改善以6～10时最显著。治疗后两组的LVEF及左室重构的指标LVMI、LVEDVI、LVESVI均较治疗前有明显改善(p<0.01),螺内酯组改善更为显著(p<0.05)。血钾两组比较无差异性,而血肌酐在螺内酯组升高,但均在正常范围。螺内酯组4例男性患者发生乳房发育,但均可耐受。结论螺内酯能够有效改善扩张型心肌病心衰患者的自主神经系统功能及左室功能,逆转心室重构。只要配合合适剂量的排钾利尿剂并注意监测血钾浓度及肾功能,应用螺内酯治疗是安全的。
Objective To observe the changes of heart rate variability （HRV）,after intervention with spironolactone,and explore the effects of spironolactone on autonomic nervous system,ventricular remodeling and its safety. Methods Sixty-seven dilated cardiomyopathy with heart failure patients （39 men and 28 women,age from 44 to 75,mean age 61.9±8.8 years） were recruited,the patients were randomly assigned to spironolactone group and conventional therapy group. Furosemide or potassium supplements were recommended according to the level of serum potassium and water retention. HRV and cardiac function parameters were measured before and 3 months after intervention. Results There were no significant differences in baseline data between the two groups. After therapy,the time domain analysis parameters：SDNN,SDANN,rMSSD and frequency domain analysis parameter were significantly improved compared with baseline in both groups,but it was more significant in spironolactone group （p〈0.05）,and the effects on the HRV indices were greatest from 6：00 to 10：00 Am. After therapy,LVEF,LVMI,LVEDVI and LVESVI were all improved compared with baseline in both groups （p〈0.01）,however,did more in spironolactone group （p〈0.05）. There were no significant differences in serum potassium between the two groups. Serum creatine increased in spironolactone group,but in the normal range. Four patients developed gynecomastia in spironolactone group. Conclusions Autonomic nervous system function and ventricular remodeling were improved more obviously in spironolactone group. It was safe to use spironolactone combined appropriate diuretics as long as we paid attention to the serum potassium level and renal function.
出处
《临床心电学杂志》
2009年第5期354-357,共4页
Journal of Clinical Electrocardiology
基金
河北省医学科学研究重点课题项目(项目编号:08068)
关键词
螺内酯
扩张型心肌病
心率变异性
自主神经
spironolaetone
dilated cardiomyopathy
HRV
autonomic nervous system
