β受体阻滞剂对不稳定性心绞痛患者心率变异性的研究

心率变异性(HRV)分析是一种无创性检测心脏自主神经调节功能的方法,用于评价某些心血管疾病的预后判断有重要价值.关于药物对HRV的影响,报道甚少,本文报道采用加服美托洛尔治疗不稳定性心绞痛(UAP),并与对照组进行比较,旨在探讨β受体阻滞剂对UAP患者HRV的作用,以及β受体阻滞剂对心脏事件的有效预防.     

选择性与非选择性β受体阻滞剂对老年冠心病的治疗价值及对心率变异性影响的对比研究

目的:探讨选择性β受体阻滞剂与非选择性β受体阻滞剂对老年冠心病的治疗价值及对心率变异性的影响。方法:应用选择性β受体阻滞剂比索洛尔与非选择性β受体阻滞剂卡维地洛治疗老年性冠心病52例,用三通道动态心电图进行24h监测,同时进行心率变异性分析。结果:应用比索洛尔和卡维地洛治疗12周后,比索洛尔和卡维地洛均可减少心肌缺血次数和时间,增加24h平均正常心动周期(NN)间期,只有比索洛尔引起迷走张力活动增加,PNN50与rMSSD均增加(P<0.05)。比索洛尔不引起SDNN和SDANN的明显改变,而卡维地洛却减少SDNN和SDANN(P<0.05)。结论:比索洛尔和卡维地洛均可以减少心肌缺血次数和时间,增加24h平均正常NN间期;非选择性β受体阻滞剂卡维地洛因可降低HRV的参数SDNN和SDANN,有可能增加心性猝死率和心血管事件的发生率。而选择性β受体阻滞剂比索洛尔可增加迷走张力,明显改善心率变异性,有可能减少心性猝死率和心血管事件的发生率。作者认为,对于老年冠心病心肌缺血的患者,尤其同时伴有心率变异性减低着,若是β受体阻滞剂治疗的适应证,以选择性β受体阻滞剂为宜。     

比索洛尔对老年慢性心力衰竭患者心率变异性的影响

目的　观察比索洛尔对老年慢性心力衰竭 (CHF)患者心率变异性的影响。方法　将 5 70例患者随机分为常规基础治疗的对照组 2 0 3例和基础治疗加比索洛尔长期治疗的试验组 3 67例 ,入院后 48h内和治疗 2 4周后进行 2 4h动态心电图心率变异性 (HRV )的分析。结果　两组HRV经治疗后均有降低 ,试验组更为明显 ,两组差异有非常显著意义 (P <0 .0 1)。结论　比索洛尔对老年慢性CHF有良好的干预作用 ,并能有效改善CHF患者的心功能。     

β受体阻滞剂对起搏器置入心衰患者左室功能的影响

目的:观察β受体阻滞剂在治疗心衰患者时对心室收缩功能的影响.方法:将安装起博器有心衰症状的左室收缩功能障碍的66例患者,起博频率调整为60次每分并随即分为两组,治疗组33例在接受ACEI或ARB,氨体舒通治疗稳定的基础上加用β受体阻滞剂治疗;对照组33例接受ACEI或ARB,氨体舒通治疗;疗程为9个月,治疗前后行心脏彩色多谱勒检查,测量左室射血分数.结果:治疗组与对照组比较,治疗组显著提高平均左室射血分数.结论:在不改变心率的条件下,β受体阻滞剂在治疗心衰患者时可维持心室收缩功能.     

β受体阻滞剂治疗慢性心衰的疗效观察

β受体阻滞曾列为治疗心衰的禁忌药品 ,但近年来在临床不断有应用它治疗慢性心力衰竭获得满意疗效的报道 ,一致肯定了β受体阻滞剂在治疗ＣＨＦ中的地位。近两年我院内科亦使用倍他乐克治疗了 36例ＣＨＦ ,取得了较满意的疗效 ,现报告如下。1　资料与方法1.1　一般资料被选择的     

β-受体阻滞剂治疗慢性充血性心衰疗效观察

作者 2 0 0 0年 7月～ 2 0 0 2年 7月对 2 0例充血性心力衰竭 (CHF)患者 ,加用 β受体阻滞剂治疗 ,现将结果报告如下。1　临床资料40例CHF患者随机分为观察组 2 0例 ,对照组 2 0例。其观察组病因依次为冠心病 8例、扩张型心肌病 6例、风湿性心脏病 4例、高血压心脏病2例 ,其中男 1 4例 ,女 6例 ,年龄 40～ 70岁 ,心功能Ⅱ级 6例 ,Ⅲ级 1 4例 (占 70 % ) ;对照组 2 0例中冠心病 9例 ,扩张型心肌病 5例 ,高血压心脏病5例 ,风湿性心脏病 3例 ,其中男 1 5例 ,女 5例 ,年龄 40～ 70岁 ,心功能Ⅱ级 5例 ,Ⅲ级 1 5例。2组患者均除外阻塞性肺疾病…     

β-受体阻滞剂治疗充血性心力衰竭的临床观察

目的　探讨β 受体阻滞剂对充血性心力衰竭 (CHF)的心率变异性 (HRV)、敏感性及心功能的变化。方法　用动态心电图进行HRV分析 ,用超声心动图测定心功能。结果　治疗组用 β 受体阻滞剂倍他乐克治疗后 ,正常RR间期指标差 ,频域指标、心率变异指数均比实验前数值增加 (P <0 .0 1,P <0 .0 5 ) ,左室射血分数 (LEF)、左室收缩末期容量和舒张末期容量均降低 (P <0 .0 5 )。结论　β 受体阻滞剂治疗充血性心力衰竭能提高其心率变异性 ,增加 β 受体敏感性 ,改善心功能。     

β受体阻滞剂联合他汀类药物治疗慢性心衰的临床有效性研究

目的:观察探究慢性心衰患者采用β受体阻滞剂联合他汀类药物治疗的临床有效性。方法:将本院2018年1月至2021年1月收治的慢性心衰患者抽取60例作为研究,分组为对照组和研究组,对照组28例患者,研究组32例患者,给予对照组实施常规治疗,给予研究组实施β受体阻滞剂联合他汀类药物治疗,将两组患者治疗后心功能指标、炎症因子水平以及临床有效性进行对比。结果:研究组治疗后左心室射血分数(LVEF)为(50.23±4.56)%,优于对照组,而左心室收缩末期内径(LVESD)以及左室舒张末期内径(LVEDD)分别为(35.98±3.73)mm、(39.38±3.76)mm,低于对照组,组间差异显著,P<0.05;在超敏C反应蛋白浓度(Hs-CRP)、白细胞介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)方面,研究组较低,分别为(4.09±1.39)mg/L、(29.89±1.06)pg/mL、(137.68±2.03)pg/mL,组间统计学意义存在,P<0.05;研究组临床有效性高于对照组,组间差异显著,P<0.05。结论:慢性心衰患者经过β受体阻滞剂联合他汀类药物治疗后,有利于改善患者心功能以及炎症因子水平,进一步提高临床有效性。     

β受体阻滞剂在心衰中的应用

β受体阻滞剂由于其明显的负性肌力作用，在心力衰竭患者中的应用一向被视为禁忌。从80年代初到90年代初，人们认识到心衰不仅是心血管系统发生病理变化，神经内分泌系统也发生变化。心衰时血液动力学异常导致神经内分泌被激活，神经内分泌活性增高进一步加重了心衰时血流动力学障碍，这就形成了恶性循环，使心衰不断恶化。随着对交感神经的激活在慢性心力衰竭中引起恶化效应的认识，以及具有抑制RNS、SNS作用的ACEI治疗心力衰竭大型试验成功的报道，使用受体阻滞剂治疗心力衰竭已成为可行的措施。     

心力衰竭患者的心率变异分析研究

目的探讨慢性心力衰竭(CHF)患者心率变异性(HRV)的变化,研究了HRV各指标与心功能程度(NYHA分级)、原发病、心衰类型的关系。方法选取CHF患者76例与正常对照组24例进行回顾性分析。结果正常对照组比较,CHF试验组SDNN,SDANN降低,差异有统计学意义。结论CHF患者HRV部分指标变化可作为判定CHF严重程度的参考指标。各项HRV指标变化大小可能与CHF患者的原发病无关,但部分似与心衰类型有关。     

慢性心力衰竭患者的心率变异性分析

目的探讨慢性心力衰竭患者的心率变异性特点及心功能损害程度与心率变异性的相关性.方法对69例慢性心力衰竭患者和52例健康对照者的心率变异性资料进行对比分析,比较不同程度心功能不全患者的心率变异性差异.结果心力衰竭组正常R-R间期总体标准差、相邻正常R-R间期差值的均方根、相邻正常R-R间期差值〉50 ms的窦性心搏占心搏总数的百分比、总功率、低频功率和高频功率低于健康对照组,低频与高频功率比值高于健康对照组（P〈0.01）.随着心功能受损程度加重,心力衰竭患者的心率变异性进一步减低,其中低频功率较敏感.结论检测心率变异性在心力衰竭患者中的变化可反映自主神经功能受损情况,同时为心力衰竭程度的预测和治疗提供有用的参考指标.     

测定慢性心力衰竭患者窦性心率震荡的临床意义

目的观察慢性心力衰竭患者窦性心率震荡(heart rate turbulence,HRT)的变化,以及与左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、心力衰竭积分的关系。方法共入选慢性心力衰竭患者83例。分别计算HRT初始值(TO)、震荡斜率(TS),对不同患者的TO、TS进行比较并分析TO和TS与LVEF、LVEDD和心力衰竭积分的相关性。结果随访12~22个月,平均(14±2)个月,死亡16例,因心力衰竭住院48例次。死亡患者与存活者相比TO显著升高[(2.4±1.2)%vs(0.9±1.2)%(P<0.001)],而TS显著降低[(2.3±0.7)ms/RRvs(3.0±0.9)ms/RR(P<0.001)];因心力衰竭住院患者与无住院患者相比TO显著升高[(1.9±1.3)%vs(0.3±0.7)%(P<0.001)],而TS显著降低[(2.5±0.9)ms/RRvs(3.4±0.8)ms/RR(P<0.001)]。应用β-受体阻滞剂的患者与未应用者相比TO显著降低,而TS显著升高,分别为(0.6±0.8)%vs(2.5±1.3)%和(3.2±0.8)ms/RRvs(2.2±0.8)ms/RR,均P<0.01;应用血管紧张素转换酶抑制剂的患者与没有应用者相比TO和TS无统计学意义,分别为(1.1±1.2)%vs(1.6±1.5)%和(2.9±0.9)ms/RRvs(2.8±1.0)ms/RR,均P>0.05。TO与LVEDD和心力衰竭积分呈显著正相关,与LVEF呈显著负相关;TS与LVEDD和心力衰竭积分呈显著负相关,与LVEF呈显著正相关,相关系数分别为0.62、0.74、-0.80、-0.46、-0.68和0.69,均P<0.01。结论慢性心力衰竭患者HRT现象减弱与心功能和预后密切相关,HRT可能成为预测慢性心力衰竭患者预后的一个新指标。     

Role of endothelin in modulation of heart rate variability in patients with decompensated heart failure

Endothelin-1 (ET-1) can modulate central and peripheral sympathetic outflow. However, if increased ET-1 levels contribute to autonomic perturbations in the setting of congestive heart failure (CHF) is not known. The purpose of this study was to determine if increased ET-1 levels contribute to the depressed HRV in patients with CHF. Sixty-four patients were admitted to the hospital for treatment of decompensated CHF (mean age 59+/-12 years, NYHA Classes III [72%] and IV [28%]). Time- and frequency-domain HRV measures were obtained from 24-hour Holter recordings. Neurohormonal activation was assessed by measuring plasma renin activity (PRA), aldosterone, norepinephrine, and ET-1 levels. Among the time-domain HRV indices, ET-1 correlated negatively with the standard deviation of RR intervals (SDNN) (r = - 0.38, P = 0.002) and standard deviation of all 5-minute mean RR intervals (SDANN5) (r = - 0.48, P < 0.0001), but not with time-domain indices indicative of parasympathetic modulation. Among the frequency-domain HRV indices, ET-1 correlated negatively with the total power (r = - 0.32, P = 0.01) and ultralow frequency power (ULF) (r = - 0.43, P = 0.0004), but not with indices of parasympathetic (high frequency) or sympathovagal (low frequency) modulation. Using multiple linear regression, adjusting for clinical parameters, drug therapies, and other neurohormones, the strong negative relationship between ET-1 and SDNN (P = 0.027), SDANN5 (P = 0.002), and ULF power (P = 0.017) persisted. In conclusion, ET-1 may play an important role in the autonomic dysfunction characteristic of CHF. The correlation between ET-1 levels and prognostically important indices of overall HRV suggests that these HRV measures are better markers of neurohormonal activation in CHF, which may partially account for their greater discriminatory power for risk stratification.     

Lorenz散点图在慢性心力衰竭患者心率变异性分析中的应用研究

目的 探讨洛伦兹(Lorenz)散点图在慢性心力衰竭患者图心率变异性(HRV)分析中的应用.方法 回顾性分析2017年9月至2020年9月安庆市立医院收治的34例心力衰竭患者的动态心电图检查资料,作为心衰组;选取同期行动态心电图检查的30例非心力衰竭患者作为对照组.比较2组HRV指标,包括时域频域指标:24 h内相邻窦...     

Effect of diabetes mellitus on heart rate variability in patients with congestive heart failure

This study sought to determine if the severity of autonomic perturbations in patients with heart failure are affected by the presence of diabetes. Decreased HRV is frequent in diabetic patients free of clinically apparent heart disease and has been invoked as a risk factor for sudden cardiac death. However, reduced HRV is also commonly present in patients with left ventricular dysfunction. The effect of diabetes on autonomic dysfunction in this setting is not known. Holter ECGs from 69 diabetic patients and 85 nondiabetic control subjects with heart failure were analyzed. The severity of autonomic dysfunction was assessed using 24-hour time- and frequency-domain HRV analysis. Prognostically important time- and frequency-domain HRV measures (SDNN, SDANN5, total power, and ultra-low frequency power) were not different between the two groups. Time- and frequency-domain parameters modulated by parasympathetic tone (pNN50, RMSSD, and HF power) were depressed to a similar degree in the diabetic and the nondiabetic groups. The low frequency power was significantly lower in diabetic patients (5.8 +/- 0.7 vs 5.3 +/- 1.0, P = 0.02). The ratio of low to high frequency power was substantially lower in the diabetic group (2.2 +/- 0.2 vs 1.4 +/- 0.2, P < 0.0001). These differences were more apparent in insulin-treated diabetics. In the presence of heart failure, HRV parameters that are most predictive of adverse outcome are similar in diabetic and nondiabetic patients. Furthermore, during increased sympathetic stimulation in the setting of heart failure, diabetes does not worsen parasympathetic withdrawal but may mitigate sympathetic activation.     

老年慢性充血性心力衰竭合并抑郁症患者的临床研究

目的 探讨抑郁症在老年慢性充血性心力衰竭(CHF)患者中的患病率情况及对预后的影响,观察综合治疗对患者抑郁状态及心功能的影响.方法 应用抑郁自评量表(SDS)评价264例老年CHF患者,将其中123例并发抑郁的患者随机分成治疗组62例和对照组61例,对照组给予常规心血管药物治疗,治疗组在常规心血管药物治疗的基础上进行综合治疗,包括抗抑郁药物治疗和心理干预,疗程3个月.治疗前后应用SDS、左心室射血分数(LVEF)、血浆N末端脑型利钠肽(NT-pro BNP)浓度、心功能进行评价,并分析各组CHF患者平均住院天数、再入院率、病死率的差异.结果 治疗组治疗后平均住院时间(23.35±6.76)天、再入院率(29.0%)、病死率(4.8%)、SDS评分(41.71±3.72)分、NT-pro BNP(2 724.21±845.17)ng/L均比对照组明显降低(P<0.05或P<0.01),LVEF(48.76±5.07)%明显增加,心功能明显改善(P<0.05).结论 抑郁症在老年CHF中的患病率高达46.6%,是心力衰竭患者预后不良的重要危险因子.综合治疗CHF患者的抑郁症疗效好,安全性高.     

Prognostic value of heart rate variability and ventricular arrhythmias during 13-year follow-up in patients with mild to moderate heart failure

Background  In contrast to patients with moderate to severe chronic heart failure (CHF), data regarding long-term outcome in patients with mild CHF are scarce. We examined the place of Holter monitoring to study the prognostic value of ventricular arrhythmias and heart rate variability (HRV) in patients with mild to moderate CHF during long-term follow-up. Methods  We studied 90 patients with mild to moderate CHF and NYHA class II who had been enrolled in the Dutch Ibopamine Multicenter Trial. At baseline their mean age was 60.5 ± 8.0 years, left ventricular ejection fraction (LVEF) was 0.29 ± 0.09, and 85% were males. At the start of the study, patients were only using diuretics, while digoxin, and particularly ACE inhibitors and β-blockers were initiated later. Univariate and multivariate proportional hazard analyses were performed. Results  At baseline 80% of patients were in NYHA class II, and 20% were in class III; their mean age was 60 years, mean LVEF was 0.29, and 85% were men. During a follow-up of 13 years, 47 patients (53%) died. Cardiovascular (CV) death occurred in 39 patients, of which 28 were sudden cardiac death (SCD). For both CV death and SCD, LVEF <30% and ventricular premature beats/h (>20) were independent risk markers. Of the HRV parameters, total power (>2,500 ms²) was an important risk marker for CV death, but not for SCD. Conclusion  The present 13-year follow-up study in 90 patients with mild to moderate CHF showed that ventricular premature beats and HRV may have important value in predicting outcome.     

Impaired nitroglycerin biotransformation in patients with chronic heart failure

OBJECTIVE: Patients with chronic heart failure (CHF) often require higher doses of nitroglycerin (glyceryl trinitrate, GTN) than patients with normal cardiac function to achieve a given haemodynamic goal. Two pathways leading to biotransformation of GTN have been characterized; a high-affinity pathway operative in nanomolar concentration ranges yielding predominantly 1,2-glyceryl dinitrate (1,2-GDN), and a low-affinity pathway operative at higher, micromolar concentrations of GTN associated with a greater proportion of 1,3-GDN formation. We tested the hypothesis that, at a given GTN-induced blood pressure reduction, the CHF group would present with: (i) higher concentrations of GTN; and (ii) decreased ratios of 1,2-GDN/GTN and 1,2-GDN/1,3-GDN compared with healthy subjects (HS). METHODS: Twelve patients with CHF (left ventricular ejection fraction 20 +/- 5%, NYHA III) and nine HS were investigated during a right cardiac catheterization. GTN was titrated intravenously until mean arterial blood pressure (MAP) was reduced by 15%. RESULTS: At arterial GTN concentrations of 27.2 [10.0-57.8] nmol l(-1) in CHF and 2.8 [2.5-3.5] nmol l(-1) in HS [median (quartile range), P<0.05 between groups], MAP and mean capillary wedge pressures were reduced similarly in both groups (approx. 15% and 65%, respectively, P = NS between groups). The ratios of 1,2-GDN/GTN and 1,2-GDN/1,3-GDN were lower in CHF (0.86 [0.28-1.58] and 5.8 [5.6-6.3]) compared with HS [1.91 (1.54-2.23) and 7.6 (7.2-10.2), P<0.05], with a negative correlation between the 1,2-GDN/1,3-GDN ratio and the arterial GTN concentrations in the CHF patients (R = -0.8, P<0.05). CONCLUSION: Patients with CHF have attenuated GTN responsiveness and decreased relative formation of 1,2-GDN in comparison with HS, indicating an altered biotransformation of GTN.     

静息心率对慢性心力衰竭合并高血压患者心功能及预后的影响

目的 探讨静息心率(resting heart rate, RHR)与慢性心力衰竭合并高血压患者心功能及预后的关系。方法 2016年9月至2017年8月于保定市第一中心医院心内科因慢性心力衰竭住院的高血压患者250例,按入院RHR水平分为3组:RHR1组,RHR＜70次/min;RHR2组,70次/min≤RHR＜90次/min;RHR3组,RHR≥90次/ min。测量患者超声心动图参数,包括左心室舒张末期内径(left ventricular end diastolic diameter, LVEDD)和左心室射血分数 (left ventricular ejection fraction, LVEF),按照纽约心脏病协会(NYHA)分级情况对患者入院、出院及随访时的心功能进行评估并记录,对比各组之间各项指标及疗效的差异,并分析其相关性。结果 随着入院RHR的升高,LVEF呈现逐渐降低的趋势（P＜0.05）, 而LVEDD、B型脑钠肽(BNP)均逐渐升高,以RHR3 组最高（P＜0.05）;RHR1组、RHR2组出院疗效及随访疗效均优于RHR3组（P＜0.05）;RHR3组入院RHR水平与出院疗效呈负相关（r=-0.251, P均＜0.05）;RHR2组、RHR3组（入院-出院）RHR差值与出院疗效、随访疗效均呈正相关（其与出院疗效相关性r值分别为0.197、0.279, 其与随访疗效相关性的r值分别为0.214、0.321, P均＜0.05）。结论 对于慢性心力衰竭合并高血压的患者,静息心率水平越高,左心功能越差,出院疗效及随访疗效也越差,积极合理的控制RHR有助于改善预后。