首页|曲美他嗪治疗缺血性心肌病心力衰竭房性心律失常的疗效观察

曲美他嗪治疗缺血性心肌病心力衰竭房性心律失常的疗效观察

Efficacy of trimetazidine in the treatment of atrial arrhythmias in ischemic cardiomyopathy and heart failure

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目的 观察曲美他嗪治疗缺血性心肌病心力衰竭导致房性心律失常患者的疗效,分析曲美他嗪对患者心功能及房性心律失常的影响.方法 选取嘉兴市第二医院2018年12月至2020年6月收治的缺血性心肌病心力衰竭患者79例进行随机对照研究,采用随机数字表法分为观察组41例、对照组38例.对照组予常规药物治疗,观察组在对照组基础上加用曲美他嗪缓释片35 mg/次,2次/d,治疗24周.分析两组治疗前后心功能指标[左心室射血分数(LVEF)、B型脑钠肽(BNP)、6 min步行距离(6MWD)]、心脏彩色多普勒超声指数[E峰与A峰比值(E/A)、左心室短轴缩短率(LVFS)]、心电图参数[P波最大时限(Pmax)、P波最小时限(Pmin)与P波离散度(Pdisp)]、动态心电图参数[单个房性早搏数量、短阵房速总数及持续时间、阵发性房扑/房颤总数及持续时间、RR间期的标准差(SDNN)、相邻RR间期差值的均方根(RMSSD)、相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)、RR间期平均值标准差(SDANN)、高频功率(HF)、低频功率(LF)]和超敏C反应蛋白(hs-CRP)的变化.结果 治疗后,观察组LVEF、BNP、6MWD、Pmax、Pdisp、房扑/房颤总数、房扑/房颤持续时间分别为(51.05±7.68)%、(1 615.59±1 129.78)ng/L、(350.02±62.99)m、(99.73±11.60)ms、(22.44± 12.03)ms、(0.22±0.61)、(4.59±12.30)min,均明显优于对照组的(46.82±7.34)%、(2 267.47±1 539.03)ng/L、(294.16±58.20)m、(111.71±10.00)ms、(36.77±15.07)ms、(0.76±1.13)、(15.66±22.30)min,差异均有统计学意义(t=-2.95、2.16、-4.08、4.89、4.68、2.69、2.76,均P<0.01).结论 曲美他嗪能改善缺血性心肌病心力衰竭患者的房性心律失常,改善其预后,值得临床推广.
Objective To investigate the efficacy of trimetazidine in the treatment of atrial arrhythmias in patients with ischemic cardiomyopathy and heart failure and analyze the effect of trimetazidine on cardiac function and atrial arrhythmias.Methods A total of 79 patients with ischemic cardiomyopathy and heart failure who received treatment at the Second Hospital of Jiaxing from December 2018 to June 2020 were included in this study.These patients were randomly divided into an observation group(n=41)and a control group(n=38).Patients in the control group received conventional drugs,while those in the observation group received trimetazidine sustained-release tablets twice daily,each time taking 35 mg in addition to conventional drugs.The treatment lasted for 24 weeks.Before and after treatment,cardiac function indicators(left ventricular ejection fraction,B-type brain natriuretic peptide,6-minute walking distance),cardiac color Doppler ultrasound indicators[ratio of early to late peak filling rate(E/A ratio)],left ventricular fractional shortening),electrocardiogram parameters(maximum P-wave duration,minimum P-wave duration,and P-wave dispersion),dynamic electrocardiogram parameters[number of single atrial premature beats,total number and duration of paroxysmal atrial tachycardia episodes,total number and duration of paroxysmal atrial flutter/fibrillation attacks,standard deviation of RR intervals,root mean square of successive differences between normal heartbeats,proportion of successive RR intervals that differ by more than 50 ms divided by the total number of NN intervals(PNN50),standard deviation of average NN intervals,high frequency and low frequency],as well as changes in high sensitivity C-reactive protein were analyzed in each group.Results After treatment,left ventricular ejection fraction,B-type brain natriuretic peptide,6-minute walking distance,maximum P-wave duration,P-wave dispersion,total number of atrial flutter/atrial fibrillation attacks,and duration of atrial flutter/atrial fibrillation in the observation group were(51.05±7.68)%,(1 615.59±1 129.78)ng/L,(350.02±62.99)m,(99.73±11.60)ms,(22.44±12.03)ms,(0.22±0.61),and(4.59±12.30)minutes,respectively,which were significantly superior to(46.82±7.34)%,(2 267.47±1 539.03)ng/L,(294.16±58.20)m,(111.71±10.00)ms,(36.77±15.07)ms,(0.76±1.13),(15.66±22.30)minutes in the control group,t=-2.95,2.16,-4.08,4.89,4.68,2.69,2.76,all P<0.01).Conclusion Trimetazidine can effectively reduce atrial arrhythmias and improve the prognosis of patients with ischemic cardiomyopathy and heart failure,which warrants clinical promotion.

Heart failureArrhythmias,cardiacCardiomyopathiesCoronary diseaseElectrocardiography,ambulatoryNatriuretic peptide,brainTrimetazidine

李澈、褚振亮、蒋芬芬、陆琴、黄忆

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嘉兴市第二医院心血管内科,嘉兴 314000

心力衰竭 心律失常,心性 心肌疾病 冠心病 心电描记术,便携式 利钠肽,脑 曲美他嗪

2024

中国基层医药
中华医学会,安徽医科大学

中国基层医药

影响因子:1.003
ISSN:1008-6706
年,卷(期):2024.31(2)
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