美托洛尔与维拉帕米对冠心病患者心率变异性的不同影响

目的:探讨非二氢吡啶钙拮抗剂(维拉帕米)与β受体阻滞剂(美托洛尔)对冠心病患者心率变异性(heart rate variability, HRV)的不同影响.方法:选取60例经冠状动脉造影确诊的冠心病患者,随机分为2组,各组30例,两组患者除常规给予相同冠心病治疗药物外,A组给予维拉帕米治疗,B组给予美托洛尔治疗,治疗持续8周,分别观察患者治疗前后诊室血压、症状、24 h动态心电图(Holter)HRV的变化.结果:治疗后两组患者心绞痛发作次数较前明显下降,组间比较差异无统计学意义.治疗后两组患者诊室血压较前明显下降,美托洛尔组治疗前为137.12/84.36 mm Hg,治疗后为131.80/77.68 mm Hg.维拉帕米组治疗前为137.72/83.92 mm Hg,治疗后为129.56/ 78.76 mm Hg.组间降幅比较差异无统计学意义(P>0.05).Holter的HRV分析显示,治疗后美托洛尔组及维拉帕米组平均心率均明显下降,时域指标正常R-R间期的标准差(standard deviation of all normal to normal R-R interval,SDNN)、HRV三角指数 (HRV triangular index,HRVTI)]均明显上升,两组间比较差异无统计学意义.两组频域指标低频(low-frequency,LF)、高频(high-frequency, HF)、总功率(total power,TP)]均明显升高,LF/HF、极低频(very-low-frequenly,VLF)均明显降低.美托洛尔组更显著(P<0.05).结论:美托洛尔和维拉帕米均可改善冠心病患者的HRV.

Effects of Verapamil and Metoprolol on heart rate variability in patients with coronary heart disease

Objective:To evaluate the effects of Verapamil and Metoprolol on improving heart rate va-riability(HRV) in patients with coronary heart disease (CHD). Methods: A total of 60 patients, who were diagnosed as CHD according to the results of coronary angiography, were enrolled. All patients were randomly divided into Verapamil group (n=30) and Metoprolol group (n=30). The patients in Verapamil group received Verapamil (480 mg/d) and the patients in Metoprolol group received Metoprolol (50 mg/d) for eight weeks. Office blood pressure, HRV, symptoms of angina Holter recording heart rates per minute and HRV for eight weeks were observed before and after treatment in both groups. Results:Both office blood pressures and the numbers of attacks of angina pectoris and symptoms all decreased obviously in the two groups after treatment. Blood pressures were reduced from 137.12/84.36 mm Hg to 131.80/77.68 mm Hg in Metoprolol group, and also reduced from 137.72/83.92 mm Hg to 129.56/78.76 mm Hg in Verapamil group (P>0.05, compared between the two groups). In both the Verapamil and Metoprolol groups, heart rates decreased, SDNN (stanard deviation of all normal to normal RR intervals) and HRVTI (HRV indexes of time-domain) both increased significantly after treatment (P>0.05). And HRV indexes of low-frequency(LF), high-frequency (HF) and total power (TP) were increased obviously, while the low-to high-frequency ratio (LF/HF), very-low-frequency (VLF) were remarkably lower(P<0.05). Compared with Verapamil group, the changes of frequency-domain indexes in Metoprolol group were significant(P<0.05). Conclusion: In patients with CHD, both Metoprolol and Verapamil can increase the HRV.