β受体阻滞剂对老年慢性心衰患者HRV与Tei指数的影响

目的通过观察心率变异性(HRV)指标与Tei指数,探讨β受体阻滞剂对心功能Ⅱ、Ⅲ级心衰患者HRV与心功能的影响。方法选择心功能Ⅱ、Ⅲ级心衰患者68例,分为β受体阻滞剂组(40例)和常规治疗组(28例),β受体阻滞剂组患者在常规治疗的基础上加用小剂量的β受体阻滞剂治疗,治疗前及治疗6月后分别检测HRV各项指标及Tei指数。结果两组的SDNN、SDANN、rMSSD、pNN50指标和Tei指数治疗后与治疗前比较,差异均有统计学意义(t分别=3.38、5.30、2.22、3.68、7.60;2.11、1.89、2.33、1.73、1.72,P均<0.05),β受体阻滞剂组与常规治疗组治疗后比较,差异亦均有统计学意义(t分别=1.75、1.83、1.87、5.06、4.59,P均<0.05)。β受体阻滞剂组LF/HF和MHR治疗后较治疗前明显下降,差异均有统计学意义(t分别=2.76、3.40,P均<0.05),与常规组治疗后比较,差异均有统计学意义(t分别=1.75、2.18,P均<0.05),而常规组治疗前后比较,差异均无统计学意义(t分别=0.04、0.16,P均>0.05)。结论随着心功能的改善,β受体阻滞剂可减慢老年慢性心衰患者平均心率,改善老年慢性心衰患者自主神经功能和心功能。

Beta-blocking agents improve heart rate variability in aged patients with chronic heart failure

Objective To observe the changes of heart rate variability（HRV） and Tei index after intervention with beta- blockade in stable chronic heart failure （CHF） patients. Methods Sixty-eight patients with moderate,stable CHF（NYHA II to III） were recruited. Twenty-eight patients were treated with optimized conventional medical therapy, and forty received beta-blocked agents treatment meanwhile. All patients underwent analysis of HRV （24-hour Hoher recording） and Tei index at baseline and after six month therapy. Results After therapy, the time domain analysis parameters, including SDNN,SDANN,rMSSD,and pNN50 were improved significantly compared with those of baseline in both groups （t= 3.38,5.30,2.22,3.68 ; 2.11,1.89,2.33,1.73, P〈 0.05 ）. Compared with the conventional group, all the parameters were improved more significantly in beta-blockade group （t=1.75,1.83,1.87,5.06,respectively for SDNN,SDANN,rMSSD,and pNN50,P〈0.05）. Mean heart rate decreased significantly in beta-blockade group （t=3.40,P〈0.05）; while it didn＇t decrease obviously in conventional group （t=0. 16,P〉0.05 ）. MHR was significantly different in patients with or without betablocker therapy （t=2.18,P〈0.05）.Frequency domain analysis parameter LF/HF was decreased in beta-blockade group （t= 2.76,P〈0.05） after therapy, although the parameters of LF and HF didn＇t change significantly; and meanwhile, it is significantly different between two groups after therapy （t=1.75 ,P〈0.05）. But LF/HF didn＇t change significantly in the conventional group （t=0.04,P〉0.05）. Tei index decreased in both groups after treatment （t=1.72,7.60, respectively for conventional group and beta-blockade group, P〈0.05） ;more significantly in patients with therapy of beta-blockade （t=4.59, P〈0.05）.Conclusions Beta-blocking agents can improve heart rate variability and heart function in aged patients with stable chronic heart failure.