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1.
目的 分析美托洛尔联合伊伐布雷定治疗稳定型心绞痛的效果。方法 选取2019年2月至2021年7月南阳医学高等专科学校第一附属医院收治的98例稳定型心绞痛患者为研究对象,按照随机数字表法分为常规组与试验组,每组49例。常规组予以美托洛尔治疗,试验组予以美托洛尔联合伊伐布雷定治疗。比较两组疗效、心绞痛发作情况、心率、肾上腺素、去甲肾上腺素水平。结果 试验组治疗总有效率为91.84%(45/49),常规组为71.43%(35/49),两组比较差异有统计学意义(P<0.05);治疗8周后,试验组心绞痛发作频率低于常规组、持续时间短于常规组(P<0.05);治疗8周后,试验组心率低于常规组(P<0.05),试验组肾上腺素、去甲肾上腺素水平低于常规组(P<0.05)。结论 美托洛尔联合伊伐布雷定治疗稳定型心绞痛患者可提高疗效,调节肾上腺素、去甲肾上腺素水平,改善心率和心绞痛发作情况。  相似文献   

2.
目的探讨伊伐布雷定治疗稳定型心绞痛的临床疗效。方法选取沈阳市红十字会医院2013-12—2014-12收治的稳定型心绞痛患者78例,随机分为对照组和治疗组各39例,对照组采用常规药物治疗,治疗组采用伊伐布雷定治疗,观察比较两组患者临床疗效、心绞痛发作次数和持续时间以及不良反应情况。结果治疗组患者治疗总有效率高于对照组,差异有统计学意义(P0.05);心绞痛发作次数和持续时间均少于对照组,差异有统计学意义(P0.05);患者不良反应发生率低于对照组,差异有统计学意义(P0.05)。结论采用伊伐布雷定治疗稳定型心绞痛,能够有效减慢患者心率,不良反应少,临床疗效显著。  相似文献   

3.
《现代诊断与治疗》2019,(23):4151-4153
目的研究小剂量酒石酸美托洛尔联合伊伐布雷定治疗慢性心力衰竭(CHF)患者的临床疗效。方法选择我院2018年1月~2019年1月收治的CHF患者125例,按照给药方案不同分为观察组63例和对照组62例。对照组给予小剂量酒石酸美托洛尔治疗,观察组给予伊伐布雷定+小剂量酒石酸美托洛尔治疗。比较两组疗效、不良反应发生率、治疗前后HR、血清NT-proBNP水平。结果观察组治疗总有效率为93.65%,高于对照组的75.81%,差异有统计学意义(P0.05);治疗后,观察组HR、血清NT-proBNP水平低于对照组,差异有统计学意义(P0.05);观察组不良反应发生率为4.76%,对照组为9.68%,两组比较差异无统计学意义(P0.05)。结论伊伐布雷定联合小剂量酒石酸美托洛尔治疗CHF患者疗效显著,能降低HR及血清NT-proBNP水平,安全性高。  相似文献   

4.
目的 探讨重组人脑利钠肽(rhBNP)联合伊伐布雷定治疗急性心肌梗死合并心力衰竭患者的临床疗效.方法 选取自2019年2月至2020年5月涿州市医院收治的168例急性心肌梗死合并心力衰竭患者为研究对象.根据随机数字表法将患者分为伊伐布雷定组与联合治疗组,每组各84例.伊伐布雷定组患者给予伊伐布雷定进行治疗,联合治疗组患者给予rhBNP联合伊伐布雷定进行治疗.比较两组患者的临床疗效、心率、血压、炎症因子水平、左心室重构以及不良反应发生情况等.结果 治疗后,两组患者的心率上升,收缩压、舒张压下降,且联合治疗组患者心率高于伊伐布雷定组,收缩压、舒张压均低于伊伐布雷定组,差异有统计学意义(P<0.05).治疗后,两组患者氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)水平下降,6 min步行距离上升,且联合治疗组患者NT-proBNP、cTnI水平均低于伊伐布雷定组,6 min步行距离长于伊伐布雷定组,差异有统计学意义(P<0.05).治疗后,两组患者肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)水平均下降,且联合治疗组患者TNF-α、IL-6、CRP水平低于伊伐布雷定组,差异有统计学意义(P<0.05).治疗后,两组患者左心射血分数(LVEF)水平上升,左室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)水平下降,且联合治疗组患者LVEF水平高于伊伐布雷定组,LVEDD、LVESD水平低于伊伐布雷定组,差异有统计学意义(P<0.05).联合治疗组患者的治疗总有效率为96.4%(81/84),明显高于伊伐布雷定组的84.5%(71/84),差异有统计学意义(P<0.05).两组患者不良反应发生情况比较,差异无统计学意义(P>0.05).结论 rhBNP联合伊伐布雷定治疗急性心肌梗死合并心力衰竭,能够抑制机体炎症因子,改善患者心率和血压水平,促进患者左心室重构,效果显著.  相似文献   

5.
目的分析伊伐布雷定与小剂量酒石酸美托洛尔治疗慢性心力衰竭患者的临床效果。方法选取我院80例慢性心力衰竭患者,根据治疗方案不同分组各40例。对照组采用小剂量酒石酸美托洛尔治疗,观察组在对照组基础上加用伊伐布雷定治疗,两组均持续治疗3个月。比较两组临床疗效、治疗前后心功能[左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、左心室收缩末期内径(LVEDs)]及运动耐力变化。结果治疗3个月后,观察组总有效率95.00%高于对照组72.50%(P0.05);观察组LVEDd、LVEF及LVEDs优于对照组(P0.05);观察组6min步行实验(6MWT)远于对照组(P0.05)。结论采取联合伊伐布雷定与小剂量酒石酸美托洛尔治疗慢性心力衰竭患者疗效显著,能有效改善心功能,提高运动耐力。  相似文献   

6.
目的 探讨伊伐布雷定联合美托洛尔治疗急性心肌梗死患者的疗效及安全性。方法 选取2021年3月至2022年10月茂名市人民医院收治的80例心肌梗死患者,按随机数字表法分为对照组与观察组,各40例。对照组在常规治疗的基础上单用美托洛尔,观察组在此基础上联合伊伐布雷定,对比两组患者的心率、血压、脑钠肽(BNP)水平、治疗效果、不良反应、30 d内住院率及死亡率。结果 治疗后,两组患者的心率、收缩压、舒张压及BNP水平均降低,且观察组均低于对照组(均P <0.05)。观察组患者的治疗总有效率高于对照组,30 d内再住院率及死亡率低于对照组患者(均P <0.05)。观察组患者出现心动过缓、低血压及呼吸困难等不良反应总发生率与对照组相近,差异无统计学意义(P>0.05)。结论 将伊伐布雷定与美托洛尔联合使用能够明显地提高急性心肌梗死患者的临床疗效,可以降低患者的心率及血压,同时不增加不良反应的发生情况,降低患者再住院率及死亡率,值得在临床上应用。  相似文献   

7.
目的 探讨经桡动脉行PCI术联合术后伊伐布雷定对冠心病患者疗效及对冠脉再狭窄发生率、血清内皮素(Endothelin, ET)水平的影响。方法 选取2021年1月—2022年8月贵州省纳雍县人民医院经桡动脉行PCI术的120例冠心病患者为研究对象,按照随机数表法分为对照组和观察组,各60例。对照组术后给予常规治疗,观察组在此基础上联合伊伐布雷定治疗。比较两组患者的临床资料、手术指标、疗效(有效率、炎性反应、复发心绞痛率)、冠脉再狭窄发生率及血清ET水平。结果 与对照组(76.67%)相比,观察组的治疗有效率(93.33%)更高,差异有统计学意义(χ2=6.614,P<0.05);观察组的C-反应蛋白、白细胞计数、心绞痛复发率、冠脉再狭窄率、血清ET水平均低于对照组,差异有统计学意义(P均<0.05)。结论 经桡动脉行PCI术联合术后伊伐布雷定能够提高冠心病患者的临床疗效,降低冠脉再狭窄发生率,降低血清ET水平。  相似文献   

8.
曾新春  李金科 《医学临床研究》2022,39(3):390-392,396
[目的]探讨伊伐布雷定联合七叶皂苷钠对老年心力衰竭合并慢性阻塞性肺疾病(COPD)患者的临床疗效.[方法]选取2019年3月至2020年6月西安交通大学第一附属医院收治的92例老年心力衰竭合并COPD患者,采用随机数字表法分为观察组(采用伊伐布雷定联合七叶皂苷钠治疗)和对照组(采用伊伐布雷定治疗),每组各46例.比较两...  相似文献   

9.
潘海燕  钱晶  潘闽  于小红 《临床荟萃》2020,35(4):317-321
目的 对急性失代偿性射血分数降低型心力衰竭(ADHFrEF)患者在常规药物治疗基础上加用伊伐布雷定,观察伊伐布雷定的临床疗效及安全性。方法 50例ADHFrEF患者随机分入对照组和观察组。对照组给予基础抗心衰治疗,观察组在对照组治疗基础上,加用伊伐布雷定5 mg,每日两次,口服,根据心率反应调整剂量。比较两组治疗前后患者心率、血压、心功能指标、血浆生化指标、平均住院时间以及主要不良心血管事件和不良反应。结果 两组患者治疗后,平均心率(HR)、BNP水平均较治疗前显著下降,6分钟步行距离(6MD)和左心室射血分数(LVEF)较治疗前显著提高(均P<0.05),左心室舒张末内径(LVEDD)和心室收缩末内径(LVESD)较治疗前缩小(均P<0.05)。与对照组比较,伊伐布雷定可进一步减慢心率,提高6MD和LVEF(均P<0.05)。结论 在基础抗心衰治疗基础上加用伊伐布雷定能进一步改善ADHFrEF患者心脏功能、提高患者运动耐量。  相似文献   

10.
目的:探讨伊伐布雷定对射血分数中间值心力衰竭(HFmrEF)患者脂蛋白磷脂酶A2(Lp?PLA2)水平及心功能的影响.方法:将64例HFmrEF患者随机分为常规治疗组(n=32)和伊伐布雷定治疗组(n=32),连续治疗24 w.在治疗前及治疗24 w后测定两组患者的Lp?PLA2、B型利钠肽(BNP),行心脏彩超测量左...  相似文献   

11.
AIM: To compare efficacy and safety of cardioselectivc beta-blockers (BB) in patients with stable angina. MATERIAL AND METHODS: An open comparative randomized trial with participation of 40 patients suffering from stable angina (NYHA FC II-III) was made. All the patients were divided into two groups. Patients of group 1 received betaxolol, those of group 2--other selective BB: metoprolol (n = 13), bisoprolol N = 6, nebivolol (n = 1). The BB dose was doubled each 2 weeks up to achievement of the maximal tolerable dose. The trial continued for 2 months during which the patients were also given aspirin, statins, ACE inhibitors, mononitrates, amlodipin and thiazide diuretics. The efficacy of the treatment was assessed by the data of the treadmill test by Brus protocol, echocardiography according to ASE recommendations, high resolution ultrasound examination of endothelium-related relaxation of the brachial artery. Lipid transport parameters were estimated with enzyme techniques. RESULTS: A mean dose of betaxolol, metoprolol and bisoprolol was 14 +/- 4.5 mg/day, 127 +/- 24 mg/ day, 10 +/- 4 mg/day. A noticeable lowering of heart rate (HR) and blood pressure (BP) was observed in both groups, but HR in group 1 decreased more (57.35 +/- 5.19 and 62.4 +/- 8.84 b/m, respectively, p = 0.033) and systolic pressure showed a trend to greater reduction. Exercise tolerance in both groups was compatible. The lowest threshold HR was achieved in betaxolol group (a fall from 133.8 +/- 23.5) to 105.0 +/- 14, 23 b/min (p+0.027). Endotheium-related relaxation of the brachial artery was improved in betaxolol group: the diameter of the artery increased from 6.38 +/- 4.32 to 9.22 +/- 4.37% (p = 0.057), the peak blood flow velocity--from 14.81 +/- 3.91 to 23.87 +/- 3.7% (p = 0.031). In group 2 a positive trend in these parameters was not observed. BB had no negative effect on left ventricular contractility, parameters of transmitral blood flow, bronchial conduction, metabolism. CONCLUSION: Compared to other BB, betaxolol had a stronger effect on hemodynamic parameters (HR and BP) at rest and exercise, improved endothelial vascular function in patients with stable angina.  相似文献   

12.
The benefit of heart rate (HR) reduction in patients with stable coronary artery disease is well demonstrated for symptom prevention and relief, and benefits on outcomes are being actively investigated. We aimed to quantify the reduction in resting HR induced by 5 antianginal drugs frequently used for symptom prevention (diltiazem, verapamil, atenolol, metoprolol, and ivabradine) in stable angina pectoris. We identified studies published between 1966 and 2007 in PubMed, Embase, and the Cochrane database and reviewed the bibliographies to locate additional studies. Eligible studies were double-blind, randomized, placebo-controlled trials in patients with stable angina. Trials were combined using weighted mean difference and fixed-effect model meta-analysis. The main outcome measure was resting HR at the study end. For diltiazem, resting HR reduction versus placebo ranged from -0.08 beats per minute (bpm) [95% confidence interval (CI) -1.5 to +1.4] for 120 mg/d to -8.0 bpm (95% CI, -11.1 to -5.0) with 360 mg/d. For sustained-release diltiazem, there was a reduction in resting HR of -4.5 bpm (95% CI, -6.4 to -2.5), with no dose-response relationship (heterogeneity P = 0.62). Resting HR reductions for the other agents were -3.2 bpm (95% CI, -5.1 to -1.3) for verapamil (with no dose-response relationship, heterogeneity P = 0.87); -19.0 bpm (95% CI, -20.4 to -17.6) for atenolol; -13.2 bpm (95% CI, -14.7 to -11.7) for metoprolol (with greater reductions for 150 mg/d and long-acting 190 mg/d); and between -9.3 bpm (95% CI, -13.8 to -4.8) and -19.6 bpm (95% CI, -23.8 to -15.4) for ivabradine. Ivabradine, atenolol, and metoprolol give similar reductions in resting HR (-10 to -20 bpm), whereas verapamil and diltiazem produce only marginal reductions (<10 bpm).  相似文献   

13.
The safety and efficacy of ivabradine applied in heart transplant (HTx) recipients with permanent sinus tachycardia (PST) has been depicted in previous short-term follow-up studies. We sought to investigate the long-term impact of ivabradine in this patient population. From May to November 2006, 29 HTx recipients with PST, who exhibited either contraindications or intolerance of beta-blocker medication or insufficient heart rate (HR) reduction on beta-blocker treatment, first received oral ivabradine treatment (5 mg bid). Ivabradine treatment was discontinued in three patients due to adverse events within the first week. In the remaining 26 patients, resting HR was significantly lowered from 106.8 ± 9.2 at baseline to 83.2 ± 5.1 bpm after 3 months (p < 0.001). This effect remained stable in the long-term follow-up (82.1 ± 11.8 bpm after 4 years), whilst blood pressure was not affected. Apart from the corrected QT interval (QTc), there were no significant changes in ECG. The elongated QTc at baseline (469.4 ± 29.5 ms) decreased to 444.3 ± 33.1 ms after 3 months ivabradine treatment (p < 0.001). A decrease in QTc until month 9 was observed, followed by a partial increase to the upper limit of the normal value. Neither allograft rejection nor changes in left ventricular ejection fraction were observed over the follow-up period. In conclusion, ivabradine appears to be a safe and feasible long-term therapeutic option for HTx recipients with PST. It reduced the resting HR without impairment of blood pressure, myocardial contractility and cardiac conduction. The prognostic value of normalised QTc following ivabradine administration requires further observation.  相似文献   

14.
目的 分析美托洛尔对冠心病心绞痛患者心率变异性的影响.方法 回顾性选取2020年1月至2021年1月本院收治的98例冠心病心绞痛患者作为研究对象,依据治疗方法将其分为常规治疗组和美托洛尔组,各49例.常规治疗组依据患者的实际病情给予个体化心内科西药治疗,美托洛尔组在常规治疗组基础上给予美托洛尔治疗.比较两组的心绞痛发作...  相似文献   

15.

Aim

Several clinical trials have demonstrated the antianginal and anti-ischemic efficacy of ivabradine in combination with beta-blocker in patients with stable angina pectoris. The ADDITIONS (PrActical Daily efficacy anD safety of Procoralan® In combinaTION with betablockerS) study evaluated the efficacy, safety, and tolerability of ivabradine added to beta-blocker, and its effect on angina symptoms and quality of life in routine clinical practice.

Methods

This non-interventional, multicenter, prospective study included 2,330 patients with stable angina pectoris treated with a flexible dose of ivabradine twice daily in addition to beta-blocker for 4 months. The parameters recorded included heart rate, number of angina attacks, nitrate consumption, tolerance, and quality of life.

Results

After 4 months ivabradine (mean dose 12.37 ± 2.95 mg/day) reduced heart rate by 19.4 ± 11.4 to 65.6 ± 8.2 bpm (p < 0.0001). The number of angina attacks was reduced by 1.4 ± 1.9 per week (p < 0.0001), and nitrate consumption by 1.9 ± 2.9 U per week (p < 0.0001). At baseline (i.e., on beta-blocker), half of the patients (51%) were classified as Canadian Cardiovascular Society (CCS) grade II; 29% were CCS grade I. After 4 months’ treatment with ivabradine, most of the patients were CCS grade I (68%). The EQ-5D index improved by 0.17 ± 0.23 (p < 0.0001). The overall efficacy of ivabradine was considered by the physicians as “very good” (61%) or “good” (36%) in most patients. Suspected adverse drug reactions were documented in 14 patients; none were severe.

Conclusion

In daily clinical practice, combining ivabradine with beta-blocker not only reduces heart rate, number of angina attacks, and nitrate consumption, but also improves the quality of life in patients with stable angina pectoris.
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16.
Chronic stable angina pectoris (CSAP) usually occurs in patients with coronary artery disease (CAD) that affects one or more large epicardial arteries. It results when myocardial perfusion is insufficient to meet cardiac metabolic demand. Elevated heart rate (HR) is an important factor in the development of myocardial ischemia and angina pectoris. The pharmacologic agents most commonly administered in the treatment of CSAP are β-blockers and calcium channel blockers (CCBs). However, the use of β-blockers is limited by poor compliance related to contraindications and comorbidities, especially in elderly patients. Ivabradine is a new selective HR-lowering agent that selectively inhibits the pacemaker current I f in the sinus atrial node. In several randomized controlled trials, ivabradine 5–10 mg twice daily has demonstrated equivalent anti-ischemic and anti-anginal activity to β-blockers and CCBs, with a good safety and tolerability profile. Although ivabradine has been shown not to improve cardiac outcomes in patients with stable CAD and left ventricular systolic dysfunction, it may be used to reduce the incidence of CAD outcomes in a subgroup of patients with HR ≥70 bpm. The aim of this short review is to summarize the use of ivabradine in the treatment of CSAP, and its potential utility in atherosclerosis, primitive and dilatative cardiomyopathy, and arrhythmias, such as postural tachycardia syndrome and inappropriate sinus tachycardia, where exclusive lowering of elevated HR may prove beneficial.  相似文献   

17.

Introduction

Heart rate (HR) reduction is an integral part of antianginal therapy, but many patients do not reach the guideline-recommended target of less than 60 bpm despite high use of beta-blockers (BB). Failure to uptitrate BB doses may be partly to blame. To explore other options for lowering HR and improving angina control, CONTROL-2 was initiated to compare the efficacy and tolerability of the combination of BBs with ivabradine versus uptitration of BBs to maximal tolerated dose, in patients with stable angina.

Methods

This multicenter, open, randomized study included 1104 patients with Canadian Cardiovascular Society (CCS) class II or III stable angina, in sinus rhythm, and on background stable treatment with non-maximal recommended doses of BBs. Consecutive patients were allocated to ivabradine + BB or BB uptitration in a 4:1 ratio.

Results

At the end of the study (week 16), addition of ivabradine to BB treatment and BB uptitration resulted in reduction in HR (61 ± 6 vs. 63 ± 8 bpm; p = 0.001). At week 16, significantly more patients on ivabradine + BB were in CCS class I than with BB uptitration (37.1% vs. 28%; p = 0.017) and significantly more patients were angina-free (50.6% vs. 34.2%; p < 0.001). Patient health status based on the visual analogue scale (VAS) was also better in the ivabradine + BB group. Adverse events (AEs) were significantly more common with BB uptitration than with the ivabradine + BB combination (18.4% vs. 9.4%, p < 0.001).

Conclusion

In patients with stable angina, combination therapy with ivabradine + BB demonstrated good tolerability, safety, and more pronounced clinical improvement, compared to BB uptitration.

Trial Registration

ISRCTN30654443.

Funding

Servier.
  相似文献   

18.
目的分析谷红注射液联合琥珀酸美托洛尔缓释片治疗冠心病心绞痛的临床价值。方法选取2019年1月至2020年4月在本院就诊的70例冠心病心绞痛患者为研究对象,根据药物治疗的方式分为参照组(n=35)与试验组(n=35)。常规治疗的同时,参照组使用琥珀酸美托洛尔缓释片治疗,试验组使用谷红注射液联合琥珀酸美托洛尔缓释片治疗,比较两组的临床指标、心功能指标、病情恢复率、炎症因子水平。结果试验组的心绞痛发作次数少于参照组,心绞痛发作持续时长短于参照组,心率低于参照组,差异具有统计学意义(P<0.05)。治疗后,两组的LVEF均升高,LVEDD及LVESD均减小,且试验组优于参照组,差异具有统计学意义(P<0.05)。试验组的病情恢复率显著高于参照组,差异具有统计学意义(P<0.05)。治疗后,两组的白细胞介素-6、超敏C反应蛋白水平均降低,且试验组低于参照组,差异具有统计学意义(P<0.05)。结论谷红注射液联合琥珀酸美托洛尔缓释片治疗冠心病心绞痛的临床价值较高,可促进患者症状的恢复,改善患者心功能。  相似文献   

19.
目的:探讨艾司洛尔对中青年急性前壁心肌梗死患者早期应用的临床效果。方法:纳入2008年1月至2020年8月苏州大学附属第二医院心血管内科收治的急性前壁心肌梗死患者,根据患者临床用药,分为美托洛尔组189例(治疗过程中β受体阻滞剂仅给予酒石酸美托洛尔缓释片)和艾司洛尔组104例(先给予艾司洛尔静脉注射,后给予酒石酸美托洛...  相似文献   

20.
目的观察曲美他嗪对稳定型劳力性心绞痛患者的疗效及运动耐量的影响。方法将100例稳定型劳力性心绞痛患者随机分为治疗组52例和对照组48例,对照组采用阿司匹林、氯吡格雷、β受体阻滞剂、他汀类,钙通道拮抗剂和硝酸酯类等药物常规治疗;治疗组在对照组治疗基础上加服盐酸曲美他嗪片20 mg,3次/d,口服,连用6个月。观察治疗前后心绞痛发作的改善情况,治疗前后检查心电图平板运动试验。结果治疗后治疗组总有效率显著高于对照组(P0.05);两组患者运动终止时(HR BP)比较差异无统计学意义(P0.05);治疗组运动时间显著长于对照组(P0.05);治疗组运动耐量显著大于对照组(P0.05)。结论曲美他嗪用于治疗稳定型劳力性心绞痛患者安全有效,并且能够改善患者的运动耐量。  相似文献   

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