摘要
目的探讨小剂量洋地黄类药物对急性心肌梗死(AMI)合并心衰患者血流动力学效应及心率变异性(HRV)的影响。方法将120例AMI合并心衰患者按随机数字表格法分为实验组和对照组各60例。两组均于经皮冠状动脉介入(PCI)再灌注治疗后给予常规抗凝、抗血小板、调脂等干预,实验组加用小剂量洋地黄类药物治疗,对照组不予此药治疗。两组治疗前后检查实验室指标,评估血流动力学效应和HRV。结果治疗后实验组纽约心脏病学会(NYHA)心功能分级提升2级者占46.67%,明显高于对照组的26.67%(P<0.05);提升1级者占46.67%,与对照组的48.33%相比,差异无统计学意义(P>0.05)。两组治疗前实验室指标血浆脑钠钛(BNP)、肿瘤坏死因子(TNF-α)浓度,血流动力学效应指标HRV相关参数水平比较,差异无统计学意义(均P>0.05);与本组治疗前相比,两组治疗后血浆BNP、TNF-α水平显著降低,左心室射血分数(LVEF)、每搏输出量(SV)、心输出量(CO)、心脏指数(CI)显著升高,各项HRV相关参数明显改善(均P<0.05);实验组治疗后血浆BNP、TNF-α水平降低幅度以及LVEF、SV、CO、CI升高幅度明显高于对照组(均P<0.05),且与对照组相比,实验组治疗后间期标准差(SDNN)、24h内连续5min节段平均正常R-R间距标准差(SDANN)、连续正常R-R间距差的均方根(rMSSD)、两个相邻R-R间距标准差≥50ms的心搏数占所分析信息间期内心搏数的百分比(PNN50)、低频功率(LF)、高频功率(HF)显著增高,LF/HF显著降低(均P<0.05);且实验组不同梗死部位患者治疗后上述指标改善效果比较无明显差异(P>0.05)。结论小剂量洋地黄类药物可有助于降低AMI合并心衰患者血浆BNP、TNF-α水平,促进心功能、血流动力学效应及HRV改善,且其治疗效果不受梗死部位影响。
Objective To explore the effects of low dose digitalis on hemodynamics and heart rate variability （HRV） in patients with acute myocardial infarction （AMI） and heart failure. Methods 120 AMI patients with heart failure were divided into the experimental group and the control group with 60 cases in each group according to the random number table method. Both groups were treated with conventional anticoagulation, antiplatelet and lipid regulation after percutaneous coronary intervention （PCI） and reperfusion therapy. The experimental group was additionally given small dose of digitalis and the control group was not treated with this drug. The laboratory indexes of the two groups were examined before and after treatment, and the hemodynamic effects and HRV were assessed. Results After treatment, increased 2 grade of New York Heart Association （NYHA） cardiac function classification of the experimental group （4667%） was significantly higher than that of the control group （P＜0.05）. The promotion of grade 1 of the experimental group and he control group were 46.67% and 48.33% （P＞0.05）. There were no significant differences in the levels of plasma brain natriuretic peptide （BNP）, tumor necrosis factor （TNFα）, hemodynamic effects and HRV related indexes between the two groups before treatment （P＞0.05）. Compared with before treatment, the plasma levels of BNP and TNFα were significantly decreased in both groups after treatment, and the levels of left ventricular ejection fraction （LVEF）, stroke volume （SV）, cardiac output （CO）, and cardiac index （CI） and the HRV related indexes were significantly improved （P＜0.05）. The decreasing degree of plasma BNP and TNFα levels and the increasing degree of LVEF, SV, CO and CI were significantly higher in the experimental group than those in the control group （P＜0.05）. And compared with the control group, the standard deviation of NN intervals （SDNN）, the 24h continuous 5min segment mean normal
出处
《西部医学》
2018年第3期379-384,共6页
Medical Journal of West China
基金
四川省科技厅科技支撑计划项目(2014SZ36891)
关键词
小剂量
洋地黄类药物
急性心肌梗死
心衰
血流动力学
心率变异性
Small dose
Digitalis
Acute myocardial infarction
Heart failure
Hemodynamics
Heart rate variability
