發(fā)布時(shí)間：2018-05-27 07:17

  本文選題：靜息心率 + 心率控制��； 參考：《南華大學(xué)》2015年碩士論文

【摘要】：目的:探討靜息心率增快對(duì)慢性心力衰竭患者心腎功能的影響,并通過(guò)進(jìn)一步強(qiáng)化心率控制,探討強(qiáng)化心率控制對(duì)慢性心力衰竭患者心臟結(jié)構(gòu)和功能、腎功能及預(yù)后的影響,旨在提高對(duì)慢性心力衰竭患者心率增快的警惕,并為臨床指導(dǎo)心率控制提供依據(jù)。方法:采用回顧性分析的方法,選取2013年8月至2014年8月在南華大學(xué)附屬婁底醫(yī)院心內(nèi)科住院的患者,結(jié)合既往心臟病史,病程超過(guò)3個(gè)月,N末端B型腦鈉肽前體(NT-pro BNP)、左室射血分?jǐn)?shù)(LVEF)等輔助檢查,有體循環(huán)和/或肺循環(huán)淤血的癥狀,診斷符合慢性心力衰竭(CHF),NYHA心功能分級(jí)Ⅲ級(jí)的患者270例,詳細(xì)記錄納入對(duì)象的一般資料、靜息心率(RHR)、NT-pro BNP、空腹血糖(FPG)、肌酐(Cre)、尿酸(UA)、胱抑素C(Cys C)、總膽固醇(TC)、甘油三脂(TG)、肌鈣蛋白I(c Tn I)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)等生化指標(biāo)結(jié)果。根據(jù)RHR是否80次/分,分為RHR增快組:166例,RHR80次/分;非RHR增快組:104例,RHR≤80次/分。比較兩組間一般資料、LVEF及生化指標(biāo),探討RHR增快對(duì)CHF患者影響。并采用前瞻性研究的方法,將入選患者隨機(jī)分組,根據(jù)是否進(jìn)行強(qiáng)化心率控制分為強(qiáng)化組:在常規(guī)治療基礎(chǔ)上,強(qiáng)化心率控制在55-65次/分;對(duì)照組:予常規(guī)治療,不予強(qiáng)化心率控制。心率控制藥物采用β受體阻滯劑—琥珀酸美托洛爾緩釋片,必要時(shí)加用地高辛。β受體阻滯劑從小劑量逐步加量至最大劑量或達(dá)到目標(biāo)心率。對(duì)照組同樣使用β受體阻滯劑或地高辛,但心率不予強(qiáng)化控制。隨訪半年,共失訪23人,死亡9人,最后強(qiáng)化組為120人,對(duì)照組為118人。通過(guò)比較強(qiáng)化心率控制前后強(qiáng)化組和對(duì)照組心臟結(jié)構(gòu)和功能、腎功能、再入院率及死亡率的改變,以探討強(qiáng)化心率控制對(duì)CHF患者的影響。結(jié)果:1、RHR增快組與非RHR增快組在性別、年齡、吸煙史、BMI、高血壓病病史、糖尿病病史等一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2、RHR增快組的LVEF低于非RHR增快組(46.67±6.92%vs 48.76±6.87%,P0.05)。生化資料中,RHR增快組NT-pro BNP高于非RHR增快組(3467.72±3600.88ng/ml vs 2665.15±2974.91ng/ml,P0.05);反應(yīng)心肌細(xì)胞損害的指標(biāo)c Tn I(0.0175±0.0046 vs 0.01624±0.0050,P0.05)、CK(168.48±87.29U/L vs 146.42±80.28 U/L,P0.05)及CK-MB(19.87±8.45U/L vs 17.81±7.82U/L,P0.05)均高于非RHR增快組;反應(yīng)腎功能的指標(biāo)中Cre(119.11±73.57umol/l vs104.16±50.86umol/l,P0.05)、UA(428.04±123.13umol/l vs393.91±114.44umol/l,P0.05)及Cys C(1.59±0.79mg/l vs 1.40±0.69mg/l,P0.05)均高于非RHR增快組。以上比較差異均有統(tǒng)計(jì)學(xué)意義。而FPG、TC和TG兩組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3、強(qiáng)化組和對(duì)照組在性別、年齡、BMI、高血壓病病史、糖尿病病史及治療前平均心率等一般資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4、強(qiáng)化心率控制治療有效率的比較,強(qiáng)化組高于對(duì)照組(63.41%vs 50.81%,P0.05)。5、強(qiáng)化組心率控制前后組內(nèi)對(duì)比LVEF(48.07±7.19%vs 52.32±6.64%,P0.001)、LEDV(143.46±12.97ml vs 133.12±13.97ml,P0.001)、LESV(70.20±13.13ml vs 60.62±10.67 ml,P0.001)差異均有統(tǒng)計(jì)學(xué)意義;對(duì)照組心率控制前后組內(nèi)對(duì)比LVEF(48.47±6.66ml vs 50.36±7.83ml,P0.05)、LEDV(142.14±17.26ml vs137.17±15.74ml,P0.05)、LESV(68.01±14.08ml vs 64.03±10.89ml,P0.05),差異均有統(tǒng)計(jì)學(xué)意義。心率控制前強(qiáng)化組和對(duì)照組組間比較LVEF、LEDV、LESV差異均無(wú)統(tǒng)計(jì)學(xué)意義;心率控制后兩組間比較LVEF(52.32±6.64%vs 50.36±7.83%,P0.05)、LEDV(133.12±13.97ml vs 137.17±15.74ml,P0.05)、LESV(60.62±10.67ml vs64.03±10.89 ml,P0.05)差異均有統(tǒng)計(jì)學(xué)意義。6、強(qiáng)化組心率控制前后組內(nèi)對(duì)比Cre(103.13±63.40umol/L vs80.31±31.88umol/L,P0.001)、Cys C(1.41±0.76mg/L vs 1.11±0.64 mg/L,P0.001)均有統(tǒng)計(jì)學(xué)意義;對(duì)照組心率控制前后組內(nèi)對(duì)比Cre(110.79±69.63umol/L vs 93.18±62.99umol/L,P0.05)、Cys C(1.53±0.89mg/L vs 1.21±0.83mg/L,P0.05)均有統(tǒng)計(jì)學(xué)意義。心率控制前強(qiáng)化組和對(duì)照組Cre和Cys C比較均無(wú)統(tǒng)計(jì)學(xué)意義;心率控制后兩組間比較Cre(80.31±31.88umol/L vs 93.18±2.99umol/L,P0.05)、Cys C(1.11±0.64mg/L vs 1.31±0.83 mg/L,P0.05),強(qiáng)化組均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義。7、強(qiáng)化組的再入院率低于對(duì)照組(5.83%vs13.56%,P0.05),兩組間死亡率比較無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1、靜息心率增快可能參與慢性心力衰竭患者心腎功能的惡化。2、強(qiáng)化心率控制可能更好的改善慢性心力衰竭患者的心腎功能及短期預(yù)后。
[Abstract]:Objective: To explore the effect of resting heart rate increasing on heart and kidney function in patients with chronic heart failure, and to explore the effect of heart rate control on heart structure and function, renal function and prognosis in patients with chronic heart failure by further strengthening heart rate control, and to improve the vigilance of heart rate increasing in patients with chronic heart failure and to guide the clinical guidance. Heart rate control provided basis. Methods: a retrospective analysis was used to select patients who were hospitalized in the Department of Cardiology, Loudi hospital, affiliated to University of South China, from August 2013 to August 2014, combined with previous history of heart disease, the course of the disease was more than 3 months, N terminal B brain natriuretic peptide precursor (NT-pro BNP), left ventricular ejection fraction (LVEF) and other auxiliary examinations, systemic circulation and / or lung The symptoms of circulating congestion were diagnosed as 270 patients with chronic heart failure (CHF) and NYHA cardiac function grade III. The general data were recorded in detail, resting heart rate (RHR), NT-pro BNP, fasting blood glucose (FPG), creatinine (Cre), uric acid (UA), Cystin C (Cys C), total cholesterol (TC), glycerin three fat, creatine kinase The results of biochemical indexes, such as creatine kinase isoenzyme (CK-MB), were divided into RHR fast group according to whether RHR 80 / min or not, 166 cases, RHR80 sub / fraction, non RHR faster group: 104 cases, RHR < 80 / sub. Compare the two groups of general data, LVEF and biochemical indexes, explore the effect of RHR fast on CHF patients, and use prospective study method to randomly group the selected patients, The intensifying heart rate control was divided into a strengthening group: on the basis of routine treatment, the heart rate control was strengthened in 55-65 times / scores; the control group was given routine treatment, and the heart rate control was not strengthened. The heart rate control drug used beta blocker Metoprolol Succinate Sustained-release Tablets, adding digoxin when necessary. The control group also used beta blocker or digoxin, but the heart rate did not strengthen control. After six months follow-up, 23 people were lost, 9 were killed, 120 in the strengthening group and 118 in the control group. The change of admission rate and mortality rate was used to investigate the effect of enhanced heart rate control on CHF patients. Results: 1, there was no significant difference in gender, age, smoking history, history of BMI, hypertension, diabetes, diabetes, and other general data between the fast group of RHR and the non RHR fast group (P0.05).2, and the LVEF in the RHR fast group was lower than that of the non RHR group (46.67 + 6.92%vs 48.). 76 + 6.87%, P0.05). In the biochemical data, the NT-pro BNP in the RHR fast group was higher than that in the non RHR faster group (3467.72 + 3600.88ng/ml vs 2665.15 + 2974.91ng/ml, P0.05), and C Tn I (0.0175 + 0.0046 0.01624 + 0.0050, 168.48 + 0.01624 + 0.0050). L, P0.05) were higher than non RHR faster groups; Cre (119.11 + 73.57umol/l vs104.16 + 50.86umol/l, P0.05), UA (428.04 + 123.13umol/l vs393.91 114.44umol/l, 1.59 + 1.40 +) were all higher than those in the non fast increasing group. There was no statistically significant difference between the two groups (P0.05).3. There was no significant difference in gender, age, BMI, history of hypertension, history of diabetes, and the average heart rate before treatment (P0.05), and the enhancement group was more effective than the control group (63.41%vs 50.81%, P0.05), and the strengthening group was higher than the control group (63.41%vs 50.81%, P0.05).5. The differences of LVEF (48.07 + 7.19%vs 52.32 + 6.64%, P0.001), LEDV (143.46 + 12.97ml vs 133.12 + 13.97ml, P0.001) and LESV (70.20 + 13.13ml vs 60.62 + 10.67 ml) were statistically significant in the group before and after the heart rate control, and the contrast group was (48.47 + 50.36 + 50.36 +, 50.36 +) before and after the control of heart rate. Vs137.17 + 15.74ml, P0.05), LESV (68.01 + 14.08ml vs 64.03 + 10.89ml, P0.05), the difference was statistically significant. Before heart rate control, there was no significant difference in LVEF, LEDV, LESV between the control group and the control group. After the heart rate control, the two groups were compared to LVEF (52.32 + 50.36 + 7.83%, 133.12). 0.05) the differences of LESV (60.62 + 10.67ml vs64.03 + 10.89 ml, P0.05) were statistically significant.6, and the comparison of Cre (103.13 + 63.40umol/L vs80.31 + 31.88umol/L, P0.001) before and after the control of heart rate in the intensive group had the significance of unified planning, and the contrast group (110.79 + 0.64) before and after the control of heart rate (1.41 + 1.11 + 0.64). Ol/L vs 93.18 + 62.99umol/L, P0.05), Cys C (1.53 + 0.89mg/L vs 1.21 + 0.83mg/L, P0.05) had statistical significance. Before heart rate control, there was no significant difference between the control group and the control group for Cre and Cys. The two groups after heart rate control were 80.31 + 93.18 + 0.83. .05), the enhanced group was lower than the control group, the difference was statistically significant.7, the reentry rate in the strengthening group was lower than that of the control group (5.83%vs13.56%, P0.05). The mortality rate between the two groups was not statistically significant. Conclusion: 1, the rate of resting heart rate may participate in the worsening.2 of heart and kidney function in patients with chronic heart failure, and the enhancement of heart rate control may better improve the chronic heart rate. Cardio renal function and short-term prognosis in patients with stress failure.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.6

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本文編號(hào)：1941006