目的 探討伊伐布雷定對老年心力衰竭患者心功能、心率變異性及NT-proBNP水平的影響。方法 選擇2016年4月—2019年4月延安大學(xué)附屬醫(yī)院治療的老年心力衰竭患者92例作為研究對象，根據(jù)入院單雙號分為對照組（n=46）和觀察組（n=46）。對照組接受常規(guī)的標(biāo)準(zhǔn)化抗心衰治療，觀察組在對照組的基礎(chǔ)上口服鹽酸伊伐布雷定片，初始劑量2.5 mg/次，2次/d，之后根據(jù)患者心率調(diào)整給藥劑量，最大劑量不超過7.5 mg/次，2次/d，控制患者靜息心率在55~65次/min，兩組均連續(xù)治療2個月。觀察兩組患者的臨床療效，同時比較兩組治療前后的心功能、心率變異性和N末端B型鈉尿肽原（NTproBNP）水平。結(jié)果 治療后，觀察組總有效率為93.48%，顯著高于對照組的78.26%，兩組總有效率比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組左心室射血分?jǐn)?shù)（LVEF）、6 min步行距離（6 MWT）均明顯升高，左室收縮末期內(nèi)徑（LVESD）和左室舒張末期內(nèi)徑（LVEDD）均顯著降低（P<0.05）；且觀察組心功能指標(biāo)顯著優(yōu)于對照組（P<0.05）。治療后兩組各心率變異性指標(biāo)及NT-proBNP水平均明顯改善（P<0.05），且觀察組各指標(biāo)顯著優(yōu)于對照組（P<0.05）。結(jié)論 伊伐布雷定可有效改善患者的心功能及心率變異性，降低NT-proBNP水平，療效確切，安全性高，對控制老年心力衰竭患者病情進展有積極意義。

Objective To investigate the effects of iavbredine on cardiac function, heart rate variability and NT-proBNP levels in elderly patients with heart failure. Methods A total of 92 elderly patients with heart failure treated in Yan'an University Affiliated Hospital from April 2016 to April 2019 were selected as the study subjects, and were divided into the control group (n=46) and the observation group (n=46) according to the odd-even number of admission. Patients in the control group were received routine standardized anti-heart failure therapy, patients in the observation group were po administered with Ivabradine Hydrochloride Tablets on the basis of control group, the initial dose was 2.5 mg/time, twice daliy, and then the dose was adjusted according to the patient's heart rate. The maximum dose was not more than 7.5 mg/time, twice daily. The resting heart rate of the patient was controlled at 55-65 times/min. Both groups were treated continuously for two months. The clinical efficacy in two groups was observed, and the cardiac function, heart rate variability, and NT-proBNP levels before and after treatment were compared between two groups. Results After treatment, the total effective rate of the observation group was 93.48%, which was significantly higher than 78.26% in the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, LVEF and 6 MWT were significantly increased in two groups, while LVESD and LVEDD were significantly decreased (P<0.05). Moreover, the cardiac function index of the observation group was significantly better than that of the control group (P<0.05). After treatment, the indicators of heart rate variability and NT-proBNP levels in two groups were significantly improved (P<0.05), and the indicators in the observation group were significantly better than those in the control group (P<0.05). Conclusion Ivabradine can effectively improve the cardiac function and heart rate variability in patients, reduce the level of NT-proBNP, the efficacy is accurate, high safety, to control the disease progression of elderly heart failure patients has a positive significance.

R972

延安市科學(xué)技術(shù)項目（7902015Y0011）