目的:探讨控制心率对心力衰竭合并心房颤动患者心力衰竭指数及心功能的影响。
方法:82例心力衰竭合并房颤患者分为对照组(41例)和研究组(41例)。对照组患者行常规治疗。除了常规治疗外,研究组患者接受美托洛尔治疗,以积极控制心率,并将静息心率降至55~60次/分作为目标心率.经过三个月的治疗,心脏功能,N末端B型利钠肽原(NT-proBNP)水平,比较两组患者的炎症因子水平。同时,计算再入院率和预后.
结果:治疗后,左心室射血分数(LVEF)和心输出量(CO)均升高,且研究组水平高于对照组;左心室收缩末期内径(LVESD)水平呈相反趋势,左心室舒张末期尺寸(LVEDD)水平,和NT-proBNP,血清CRP,TNF-α和IL-6水平(均P<0.05)。经过六个月的随访,再入院率和心力衰竭率,研究组不良事件发生率低于对照组(均P<0.05)。
结论:有效控制心室率可更显著地改善心力衰竭症状和心房颤动。缓解炎症反应,从而改善心力衰竭合并心房颤动患者的心功能和预后。
OBJECTIVE: To explore the effect of controlling the heart rate on the heart failure index and on heart function in patients with heart failure and atrial fibrillation.
METHODS: 82 patients with heart failure and atrial fibrillation were divided into a control group (n=41) and a study group (n=41). The patients in the control group underwent conventional treatment. In addition to the conventional treatment, the patients in the study group were administered metoprolol to actively control their heart rates and to decrease their resting heart rates down to 55-60 beats/min as the target heart rate. After three months of treatment, the heart function, the levels of N terminal pro B type natriuretic peptide (NT-proBNP), and the inflammatory factors were compared between the two groups. At the same time, the readmission rates and prognoses were calculated.
RESULTS: After the treatment, the left ventricular ejection fraction (LVEF) and the cardiac output (CO) levels in the two groups were increased, and the levels in the study group were higher than the levels in the control group; there were opposite trends in the left ventricular end-systolic diameter (LVESD) levels, the left ventricular end-diastolic dimension (LVEDD) levels, and the NT-proBNP, serum CRP, TNF-α and IL-6 levels (all P<0.05). After a six month follow up, the readmission and heart failure rates, and the incidence of adverse events in the study group were lower than they were in the control group (all P<0.05).
CONCLUSIONS: The effective control of the ventricular rate can more significantly benefit the heart failure symptoms and atrial fibrillation, alleviate the inflammatory response, and thus improve the heart function and prognoses of heart failure patients with atrial fibrillation.