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目的比较高血压不同临床类型心力衰竭患者的心率震荡现象,并研究比索洛尔的干预作用。方法选择2007-10-2010-12在我院心内科住院的原发性高血压患者148例,根据临床症状及超声心动图结果分为:单纯舒张性心力衰竭组(A组,n=34)、单纯收缩性心力衰竭组(B组,n=38)和混合性心力衰竭组(有收缩性和舒张性心功能不全,C组,n=40),并以无心力衰竭的原发性高血压患者36例为对照组,根据是否服用比索洛尔,各组又分为基础治疗组和比索洛尔治疗组,利用24h动态心电图分析系统获得其室性早搏,分别计算治疗前及治疗后4周不同分组的震荡初始和震荡斜率。结果治疗前震荡斜率:C组(4.67±1.78)B组(0.58±0.74)%>A组(0.45±0.62)%>对照组(0.35±0.56)%,组间比较差别均有统计学意义(P<0.05);与治疗前比较,治疗后4组中基础治疗组和比索洛尔组震荡初始值均明显降低,震荡斜率值均明显升高(P<0.01);协方差分析显示,校正治疗前震荡初始和震荡斜率的影响后,比索洛尔治疗较基础治疗能进一步降低B组和C组的震荡初始值(F=12.36,F=9.81,均P<0.01),升高震荡斜率值(F=8.89,F=16.59,均P<0.01),而在A组和对照组,比索洛尔治疗和基础治疗对震荡初始及震荡斜率的影响无统计学意义。结论原发性高血压伴有心力衰竭的患者心率震荡减弱,混合性心力衰竭及收缩性心力衰竭较舒张性心力衰竭更为明显,比索洛尔可明显改善原发性高血压混合性心力衰竭和单纯收缩性心力衰竭患者心率震荡现象。
Objective To compare the heart rate turbulence in patients with different clinical types of heart failure and to study the intervention effect of bisoprolol. Methods A total of 148 patients with essential hypertension who were hospitalized in Department of Cardiology of our Hospital from October 2007 to October 2010 were divided into two groups according to clinical symptoms and echocardiography: group A (n = 34), diastolic heart failure , Simple systolic heart failure group (group B, n = 38) and mixed heart failure group (systolic and diastolic heart insufficiency, group C, n = 40), and without primary heart failure 36 patients with blood pressure as control group, according to whether taking bisoprolol, each group is divided into basic treatment group and bisoprolol treatment group, the use of 24h dynamic electrocardiogram analysis of ventricular premature beats, were calculated before and after treatment 4 Oscillation initial and concussion slopes for different groups of weeks. Results The concussion slope before treatment: C group (4.67 ± 1.78) 0.58 ± 0.74% in group B, 0.45 ± 0.62% in group A, and 0.35 ± 0.56% in control group. There was significant difference between the two groups (P <0.05) After treatment, the initial values of shock in both the basic treatment group and the bisoprolol group were significantly decreased, and the oscillation slope values were significantly increased (P <0.01). Covariance analysis showed that after correction of the initial shock and the slope of oscillation, Bisoprolol treatment more than the basic treatment can further reduce the shock group B and C initial value (F = 12.36, F = 9.81, both P <0.01), increased oscillation slope value (F = 8.89, F = 16.59, <0.01), while in group A and control group, the effect of bisoprolol and basic treatment on the initial shock and the slope of oscillation was not statistically significant. Conclusions Patients with essential hypertension complicated with heart failure have weaker heart rate turbulence, combined heart failure and systolic heart failure are more obvious than those with diastolic heart failure. Bisoprolol can significantly improve essential hypertension complicated with heart failure and Heart rate turbulence in patients with isolated systolic heart failure.