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伊伐布雷定治疗维持性血液透析期间合并慢性心力衰竭的终末期肾病患者的临床观察
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| 篇名： | 伊伐布雷定治疗维持性血液透析期间合并慢性心力衰竭的终末期肾病患者的临床观察 |
| TITLE： | Clinical observation of ivabradine in the treatment of chronic heart failure in end-stage renal disease patients undergoing maintenance hemodialysis |
| 摘要： | 目的 考察伊伐布雷定治疗维持性血液透析（MHD）期间合并慢性心力衰竭（CHF）的终末期肾病患者的有效性和安全性。方法选择2021年5月至2023年9月在我院治疗且符合纳入标准的MHD期间合并CHF的终末期肾病患者作为研究对象，采用随机数字表法将其分为对照组和观察组，各60例。两组患者均接受MHD，每次4h，每周3次，并采用低分子量肝素钠抗凝，同时均予以CHF常规治疗方案；观察组患者在上述治疗基础上口服盐酸伊伐布雷定片5mg，每天2次（2周后若静息心率高于60次/min，则药物剂量增加至7.5mg，每天2次）。两组患者均连续治疗6个月。比较两组患者的临床疗效，治疗前后生命体征、心功能、心力衰竭相关标志物水平、炎症因子水平，透析相关低血压发生率及药物不良反应总发生率。结果观察组患者的有效率（92.45%）显著高于对照组（76.47%），透析相关低血压发生率（20.75%）显著低于对照组（41.18%）（P＜0.05）。观察组患者治疗后的心率、左室收缩末内径、左室舒张末内径和血清氨基末端脑利钠肽前体、癌抗原125、肿瘤坏死因子α、白细胞介素6、超敏C反应蛋白水平均显著低于或小于对照组（P＜0.05）；左室射血分数、心输出量均显著高于对照组（P＜0.05）。两组患者治疗后的舒张压、收缩压以及治疗期间药物不良反应总发生率比较，差异均无统计学意义（P＞0.05）。结论伊伐布雷定可显著改善MHD期间合并CHF的终末期肾病患者的心功能，抑制心室重塑，下调患者血清氨基末端脑利钠肽前体、癌抗原125水平，降低机体炎症水平以及透析相关低血压发生率，临床效果显著且安全性良好。 |
| ABSTRACT： | OBJECTIVE To investigate the efficacy and safety of ivabradine in the treatment of end-stage renal disease patients with chronic heart failure （CHF） during maintenance hemodialysis （MHD）. METHODS End-stage renal disease patients with CHF during MHD who were treated in our hospital from May 2021 to September 2023 and met the inclusion criteria were selected as the study subjects. They were randomly divided into control group and observation group， with 60 cases in each group， using a random number table method. Both groups of patients received MHD three times a week for 4 hours each time and were anticoagulated with low-molecular weight heparin sodium. At the same time， they were treated with CHF conventional therapy； based on the above treatment， observation group was orally administered Ivabradine tablets 5 mg， twice a day （if the resting heart rate was above 60 beats/min after 2 weeks， the drug dose was increased to 7.5 mg， twice a day）. Both groups of patients were treated continuously for 6 months. The clinical efficacy of 2 groups was compared as well as vital signs， cardiac function， the levels of heart failure- related biomarkers and inflammatory factors before and after treatment， and the incidences of dialysis-related hypotension and adverse drug reactions. RESULTS The effective rate of the observation group （92.45%） was significantly higher than that of the control group （76.47%）， and the incidence of dialysis-related hypotension （20.75%） was significantly lower than that of the control group （41.18%） （P＜0.05）. The heart rate， the levels of left ventricular end-systolic diameter， left ventricular end-diastolic diameter， serum N-terminal pro-B-type natriuretic peptide， cancer antigen 125， tumor necrosis factor-α， interleukin-6， and hypersensitive C-reactive protein in observation group after treatment were significantly lower than those of control group （P＜0.05）； the left ventricular ejection fraction and cardiac output were significantly higher than those in the control group （P＜0.05）. There was no statistically significant difference in the diastolic blood pressure， systolic blood pressure， or the total incidence of adverse drug reactions between the two groups after treatment （P＞0.05）. CONCLUSIONS Ivabradine can significantly improve cardiac function， inhibit ventricular remodeling， down-regulate serum levels of serum N-terminal pro-B-type natriuretic peptide and cancer antigen 125， decrease body inflammation levels and the incidence of dialysis-related hypotension in end-stage renal disease patients with CHF during MHD， with significant clinical effects and good safety. |
| 期刊： | 2025年第36卷第01期 |
| 作者： | 谭刚；李永芳；周广朋 |
| AUTHORS： | TAN Gang，LI Yongfang，ZHOU Guangpeng |
| 关键字： | 伊伐布雷定；终末期肾病；维持性血液透析；慢性心力衰竭；心功能；炎症 |
| KEYWORDS： | ivabradine； end-stage renal disease； maintenance hemodialysis； chronic heart failure； heart function； inflammation |
| 阅读数： | 13 次 |
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