早期应用伊伐布雷定在急性ST段抬高型心肌梗死伴心功能Killip Ⅱ级患者中的疗效分析

Early application of ivabradine in patients with acute ST segment elevation myocardial infarction with Killip Ⅱ

关键词:  伊伐布雷定  STEMI  心力衰竭

Key words:  ivabradine  ST segment elevation myocardial infarction  heart failure

摘要:

目的 分析伊伐布雷定在急性ST段抬高型心肌梗死（STEMI）伴Killip Ⅱ级患者治疗中的疗效。方法 选取83例STEMI伴Killip Ⅱ级患者，其中32例患者应用伊伐布雷定，为观察组。其余51例患者应用常规治疗，为对照组。分析两组患者治疗前、出院前BNP水平变化；治疗前、出院前以及出院1个月后心率变化，出院前及出院1个月后左心室射血分数（LVEF）、左心室舒张末内径（LVEDD）变化；出院前ACEI/ARB及β受体阻滞剂的启动时间。结果 经过治疗，出院前观察组患者BNP水平下降更为明显（P<0.05）；观察组患者出院1个月后心率较对照组显著下降（P<0.05）；LVEF较对照组显著升高（P<0.05）；观察组患者ACEI/ARB、β受体阻滞剂的启动时间早于对照组（P<0.05）。结论 伊伐布雷定有效降低STEMI伴Killip Ⅱ级患者心率，改善心功能，增加心输出量，并帮助ACEI/ARB、β受体阻滞剂的启动。

Abstract:

Objective To analyze the efficacy of ivabradine in the treatment of acute ST segment elevation myocardial infarction (STEMI) complicated with Killip Ⅱ. Methods The clinical data of 83 STEMI patients complicated with Killip Ⅱ were retrospectively analyzed. The control group (n=51) received conventional therapy, and ivabradine was added in the observation group (n=32) with conventional therapy. Before and after treatment, BNP levels, heart rate, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), and the start-up time of ACEI/ARB and β-blockers were analyzed in the two groups. Results After treatment, the BNP level of observation group decreased more significantly (P<0.05) before discharge; the heart rate of observation group was significantly lower than that of control group one month after discharge (P<0.05); the LVEF of observation group was higher than that in control group one month after discharge (P<0.05); and the start time of ACEI/ARB and beta blocker of observation group was earlier than that in control group (P<0.05). Conclusion ivabradine can effectively reduce heart rate, improve cardiac function, increase cardiac output, and help start ACEI/ARB and beta blocker in STEMI patients complicated with Killip Ⅱ.