早期应用艾司洛尔治疗射血分数减低心力衰竭合并2型糖尿病患者的临床研究

Esmolol Combined with Metoprolol Succinate in the Treatment of Patients with Type 2 Diabetes and Heart Failure with Reduced Ejection Fraction

摘要: 目的：探讨射血分数降低的心力衰竭(HFrEF)合并2型糖尿病患者早期静脉应用β受体阻滞剂的疗效及安全性。方法：采取回顾性病例对照研究方法，应用青岛大学附属医院his病历系统选取2017年09月~2019年06月在青岛大学附属医院全科医学科住院的HFrEF合并2型糖尿病患者120例，根据患者是否应用艾司洛尔分成观察组和对照组，对照组采用降糖及抗心衰标准治疗加口服琥珀酸美托洛尔治疗；观察组采用降糖及抗心衰标准治疗加持续静脉泵入艾司洛尔，连用3天后改为口服琥珀酸美托洛尔。观察180天，比较2组患者在静息心率、6分钟步行试验(6-Minute Walk Test, 6MWT)、左心室射血分数(Left Ventricular Ejection Fraction, LVEF)、左心房内径(Left Atrium Diameter, LAD)、左心室舒张末期内径(Left Ventricular End Diastolic Diameter, LVEDD)等方面的差异。结果：1) 观察组在静息心率达标率、静息心率达标时间、6分钟步行试验、左心室射血分数等方面的疗效均明显优于对照组，差异有统计学意义(P < 0.05)；左心房内径、左心室舒张末期内径两组对比结果无统计学差异(P > 0.05)。2) 在第3天、第7天、第14天，观察组静息心率达标率(41.7%、91.7%、96.7%)明显高于对照组(5%、36.7%、83.3%)，且达标时间明显早于对照组，差异有统计学意义(P < 0.05)。3) 出院后6个月内，观察组患者因心衰再住院率为7.02% (4/57)，明显低于对照组18.97% (11/58)，两组对比差异有统计学意义(P < 0.01)。4) 观察期间，两组患者均未出现药物相关的肝肾功异常、症状性低血压、二度或三度房室传导阻滞、严重心动过缓等不良事件。结论：早期静脉应用艾司洛尔治疗射血分数减低心力衰竭合并2型糖尿病患者的静息心率达标时间明显提前，心功能及活动耐量明显改善。

Abstract: Objective: To explore the efficacy and safety of early intravenous β-blockers in patients with heart failure (HFrEF) with reduced ejection fraction and type 2 diabetes. Methods: A retrospective case-control study method was used to select 120 patients with HFrEF and type 2 diabetes who were hospitalized in the Department of General Medicine, the Affiliated Hospital of Qingdao University from September 2017 to June 2019 using the medical record system of the Affiliated Hospital of Qingdao University. Esmolol was divided into the observation group and the control group. The control group was treated with standard hypoglycemic and anti-heart failure treatment plus oral metoprolol succinate; the observation group was treated with hypoglycemic and anti-heart failure standard treatment plus continuous intravenous pumping. Esmolol, after 3 days of continuous use, changed to oral metoprolol succinate. Observed for 180 days, the differences in resting heart rate, 6-minute walk test (6MWT), left ventricular ejection fraction (LVEF), left atrial inner diameter (LAD), left ventricular end diastolic diameter (LVEDD), etc. were compared between the two groups. Results: 1) The observation group was significantly better than the control group in terms of resting heart rate compliance rate, resting heart rate compliance time, 6-minute walk test, and left ventricular ejection fraction, and the difference was statistically significant (P < 0.05); the left atrium inner diameter and left ventricular end-diastolic diameter were not statistically different between the two groups (P > 0.05). 2) On the 3rd, 7th, and 14th days, resting heart rate compliance rate of the observation group (41.7%, 91.7%, 96.7%) was significantly higher than that of the control group (5%, 36.7%, 83.3%), and the time to reach the standard was significantly earlier than that of the control group; the difference was statistically significant (P < 0.05). 3) Within 6 months after discharge, the rehospitalization rate of patients in the observation group due to heart failure was 7.02% (4/57), which was significantly lower than 18.97% (11/58) of the control group. The difference between the two groups was statistically significant (P < 0.01). 4) During the observation period, there were no adverse events such as drug-related liver and kidney dysfunction, symptomatic hypotension, second-degree or third-degree atrioventricular block, and severe bradycardia. Conclusion: Early intravenous application of esmolol in the treatment of patients with heart failure with reduced left ventricular ejection fraction and type 2 diabetes reduced the ejection fraction. The resting heart rate reached the target time significantly earlier, and the cardiac function and exercise tolerance were significantly improved.