静息心率增快及强化心率控制对慢性心力衰竭患者心肾功能的影响

发布时间：2018-05-27 07:17

本文选题：静息心率 + 心率控制　；参考：《南华大学》2015年硕士论文

【摘要】：目的:探讨静息心率增快对慢性心力衰竭患者心肾功能的影响,并通过进一步强化心率控制,探讨强化心率控制对慢性心力衰竭患者心脏结构和功能、肾功能及预后的影响,旨在提高对慢性心力衰竭患者心率增快的警惕,并为临床指导心率控制提供依据。方法:采用回顾性分析的方法,选取2013年8月至2014年8月在南华大学附属娄底医院心内科住院的患者,结合既往心脏病史,病程超过3个月,N末端B型脑钠肽前体(NT-pro BNP)、左室射血分数(LVEF)等辅助检查,有体循环和/或肺循环淤血的症状,诊断符合慢性心力衰竭(CHF),NYHA心功能分级Ⅲ级的患者270例,详细记录纳入对象的一般资料、静息心率(RHR)、NT-pro BNP、空腹血糖(FPG)、肌酐(Cre)、尿酸(UA)、胱抑素C(Cys C)、总胆固醇(TC)、甘油三脂(TG)、肌钙蛋白I(c Tn I)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)等生化指标结果。根据RHR是否80次/分,分为RHR增快组:166例,RHR80次/分;非RHR增快组:104例,RHR≤80次/分。比较两组间一般资料、LVEF及生化指标,探讨RHR增快对CHF患者影响。并采用前瞻性研究的方法,将入选患者随机分组,根据是否进行强化心率控制分为强化组:在常规治疗基础上,强化心率控制在55-65次/分;对照组:予常规治疗,不予强化心率控制。心率控制药物采用β受体阻滞剂—琥珀酸美托洛尔缓释片,必要时加用地高辛。β受体阻滞剂从小剂量逐步加量至最大剂量或达到目标心率。对照组同样使用β受体阻滞剂或地高辛,但心率不予强化控制。随访半年,共失访23人,死亡9人,最后强化组为120人,对照组为118人。通过比较强化心率控制前后强化组和对照组心脏结构和功能、肾功能、再入院率及死亡率的改变,以探讨强化心率控制对CHF患者的影响。结果:1、RHR增快组与非RHR增快组在性别、年龄、吸烟史、BMI、高血压病病史、糖尿病病史等一般资料比较,差异无统计学意义(P0.05)。2、RHR增快组的LVEF低于非RHR增快组(46.67±6.92%vs 48.76±6.87%,P0.05)。生化资料中,RHR增快组NT-pro BNP高于非RHR增快组(3467.72±3600.88ng/ml vs 2665.15±2974.91ng/ml,P0.05);反应心肌细胞损害的指标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增快组;反应肾功能的指标中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增快组。以上比较差异均有统计学意义。而FPG、TC和TG两组间比较差异无统计学意义(P0.05)。3、强化组和对照组在性别、年龄、BMI、高血压病病史、糖尿病病史及治疗前平均心率等一般资料比较差异无统计学意义(P0.05)。4、强化心率控制治疗有效率的比较,强化组高于对照组(63.41%vs 50.81%,P0.05)。5、强化组心率控制前后组内对比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)差异均有统计学意义;对照组心率控制前后组内对比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),差异均有统计学意义。心率控制前强化组和对照组组间比较LVEF、LEDV、LESV差异均无统计学意义;心率控制后两组间比较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)差异均有统计学意义。6、强化组心率控制前后组内对比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)均有统计学意义;对照组心率控制前后组内对比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)均有统计学意义。心率控制前强化组和对照组Cre和Cys C比较均无统计学意义;心率控制后两组间比较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),强化组均低于对照组,差异有统计学意义。7、强化组的再入院率低于对照组(5.83%vs13.56%,P0.05),两组间死亡率比较无统计学意义。结论:1、静息心率增快可能参与慢性心力衰竭患者心肾功能的恶化。2、强化心率控制可能更好的改善慢性心力衰竭患者的心肾功能及短期预后。
[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.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.6

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