伊伐布雷定片联合左西孟旦在急性心肌梗死合并心力衰竭患者中的应用

doi:10.3969/j.issn.1006-5725.2024.02.020

Abstract

Abstract:

Objective To observe the efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction complicated with heart failure. Methods A total of 78 patients with acute myocardial infarction complicated with heart failure admitted to the hospital from May 1， 2020 to December 31， 2022 were selected and divided into control group （n = 39） and study group （n = 39） by random number table method. In addition to basic treatment，the control group received levosimendan， and the study group ivabradine and levosimendan. The treatment period of both groups was 4 weeks. Compare two groups of patients' vital signs， clinical curative effect and heart function index， serological indexes， inflammatory factors and security. Results Compared with before treatment， the systolic blood pressure， diastolic blood pressure and heart rate of the two groups were decreased after treatment （P < 0.05）， and the systolic blood pressure， heart rate， diastolic blood pressure and heart rate of the study group were significantly decreased compared with the control group （P < 0.05）. Compared with the control group， the total effective rate of the study group was significantly higher （P < 0.05）. Compared with before treatment， the levels of CO and LVEF were increased （P < 0.05）， while the levels of LVEDV and LVESV were decreased （P < 0.05）. Compared with the control group， the levels of CO and LVEF in the study group were higher （P < 0.05）， and the levels of LVEDV and LVESV in the study group were lower （P < 0.05）. Compared with before treatment， the levels of cTnI， sST2 and NT-proBNP in both groups were decreased after treatment （P < 0.05）， and the serum levels of cTnI， sST2 and NT-proBNP in the study group were significantly decreased compared with the control group （P < 0.05）. Tumor necrosis factor α （TNF-α）， myeloperoxidase （MPO） and highly sensitive C-reactive protein （hs-CRP） were all decreased after treatment in the two groups （P < 0.05）， and those in the study group were much lower （P < 0.05）No difference between the incidence of adverse reactions to the total contrast the two groups （P > 0.05）. Conclusion Levosimendan combined with ivabadinehave a definite effect on patients with acute myocardial infarction complicated with heart failure for the improved cardiac function， reduced inflammation， regulated serum sST2， cTnI， and NT-proBNP level. It is also safe and reliable

Key words: ivabradine, levosimendan, acute myocardial infarction, heart failure, clinical effect, security

CLC Number:

Xian WEN,Xianfeng ZENG,Ruiya SU. Efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction complicated with heart failure[J]. The Journal of Practical Medicine, 2024, 40(2): 242-247.

Figures/Tables 7

Tab.1

Tab.2

Tab.3

Comparison of clinical efficacy between the two groups"

组别	显效	有效	无效	总有效率
对照组（n = 39）	20（51.28）	9（23.08）	10（25.64）	29（74.36）
研究组（n = 39）	28（71.79）	8（20.51）	3（7.69）	36（92.31）
$χ 2$ 值				4.523
P值				0.033

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

Comparison of patient safety between the two groups"

组别	心动过缓	便秘	低钾血症	心悸	总发生率
对照组（n = 39）	1（2.56）	1（2.56）	1（2.56）	1（2.56）	4（10.26）
研究组（n = 39）	1（2.56）	1（2.56）	2（5.13）	2（5.13）	6（15.38）
$χ 2$ 值					0.459
P值					0.498

Tab.7

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指标	对照组（n = 39）	研究组（n = 39）	t/χ²值	P值
年龄（岁）	56.73（%）	55.24 ± 8.76	0.766	0.446
性别［例（%）］			0.212	0.645
男	22	24
女	17	15
BMI（kg/m²）	22.35 ± 8.76	22.47 ± 2.23	0.240	0.811
发病至入院时间（h）	3.50 ± 0.49	3.59 ± 0.46	0.836	0.406
心功能Killip分级［例（%）］			0.205	0.651
Ⅱ级	20	18
Ⅲ级	19	21
高血压［例（%）］	12（30.7）	10（25.6）	0.253	0.615
糖尿病［例（%）］	10（25.6）	7（17.9）	0.677	0.411
高脂血症［例（%）］	9（23.1）	8（20.5）	0.075	0.784
急性心肌梗死部位［例（%）］			0.482	0.488
前壁	25（64.1）	22（56.4）
下壁	14（35.9）	17（43.6）
心肌肌钙蛋白I（μg/L）	5.62 ± 1.05	5.53 ± 1.01	0.386	0.701
乳酸脱氢酶（U/L）	498.74 ± 52.69	501.36 ± 54.25	0.216	0.829
肌酸激酶（U/L）	162.31 ± 54.25	159.87 ± 18.97	0.551	0.583

组别	舒张压（mmHg）		收缩压（mmHg）		心率（次/min）
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组（n = 39）	99.27 ± 7.38	86.24 ± 6.10^*	160.39 ± 10.72	137.25 ± 9.30^*	106.58 ± 12.34	95.44 ± 10.51^*
研究组（n = 39）	98.40 ± 7.56	73.35 ± 5.28^*	158.41 ± 10.33	124.19 ± 8.12^*	108.26 ± 12.76	81.05 ± 8.28^*
t值	0.514	9.978	0.831	6.606	0.591	6.717
P值	0.609	< 0.001	0.409	< 0.001	0.556	0.000

组别	CO（L/min）		LVESV（mL）		LVEF（%）		LVEDV（mL）
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组（n=39）	2.41 ± 0.38	3.83 ± 0.57^*	64.57 ± 3.40	54.31 ± 2.35^*	34.24 ± 3.78	45.38 ± 4.51^*	126.81 ± 11.30	118.41 ± 9.38^*
研究组（n=39）	2.46 ± 0.39	5.69 ± 0.74^*	64.79 ± 3.43	43.26 ± 1.48^*	34.52 ± 3.91	50.67 ± 5.82^*	125.23 ± 11.49	110.35 ± 7.20^*
t值	0.573	12.435	0.284	24.848	0.322	4.487	0.612	4.257
P值	0.568	< 0.001	0.777	< 0.001	0.749	< 0.001	0.542	< 0.001

组别	sST2（μg/L）		cTnI（μg/L）		NT-proBNP（ng/L）
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组（n=39）	0.69 ± 0.14	0.48 ± 0.10^*	7.53 ± 1.65	3.75 ± 0.46^*	4 478.32 ± 872.58	2 697.45 ± 361.43^*
研究组（n=39）	0.72 ± 0.15	0.26 ± 0.05^*	7.64 ± 1.69	0.82 ± 0.17^*	4 561.29 ± 875.33	1 869.24 ± 175.38^*
t值	0.913	12.289	0.291	37.311	0.419	12.875
P值	0.364	< 0.001	0.772	< 0.001	0.676	< 0.001

组别	TNF-α（ng/L）		MPO（μg/L）		hs-CRP（mg/L）
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组（n=39）	29.57 ± 4.46	21.68 ± 3.53^*	569.34 ± 55.27	497.82 ± 50.31^*	42.97 ± 5.69	28.34 ± 4.38^*
研究组（n=39）	29.13 ± 4.65	15.29 ± 2.30^*	571.58 ± 56.42	451.06 ± 44.25^*	42.32 ± 5.40	17.69 ± 3.21^*
t值	0.426	9.472	0.177	4.358	0.517	12.248
P值	0.671	< 0.001	0.860	< 0.001	0.606	< 0.001

Efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction complicated with heart failure

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