中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

吸入抗胆碱能药物对稳定期慢性阻塞性肺疾病患者运动后心率恢复的影响

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目的 探讨吸入抗胆碱能药物对稳定期慢性阻塞性肺疾病(简称慢阻肺)患者运动后心率恢复(HRR)的影响。 方法 研究共纳入了 60 例Ⅱ~Ⅳ期稳定期慢阻肺的患者。其中,用药组患者 28 例,规律应用噻托溴铵≥1 年;对照组患者 32 例,未用吸入性药物治疗。观察两组患者运动后 HRR 的情况以反映抗胆碱能药物对心脏自主功能的影响。 结果 用药组患者 HRR 显著低于对照组[(16±6)次/min 比(22±8)次/min,P<0.05]。多元线性回归分析表明,在慢阻肺患者中,应用抗胆碱能药物是 HRR 的独立影响因子。 结论 抗胆碱能药物会影响稳定期慢阻肺患者心脏自主神经功能

Objective To investigate the effect of inhaled anticholinergics on heart rate recovery (HRR) in patients with stable chronic obstructive pulmonary disease (COPD). Methods Sixty clinically stable patients with stage Ⅱ-Ⅳ COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines were recruited. HRR was analyzed in this study between 28 patients who had received tiotropium≥1 year and 32 patients who never used anticholinergics as control, so as to reflect parasympathetic reactivity of the heart. Results HRR was significantly lower in the subjects with tiotropium than that in the controls [(16±6) beats/min vs. (22±8) beats/min, P<0.05]. Multivariate regression analysis revealed that anticholinergics medication could be used as an independent predictor of HRR in the COPD patients. Conclusion Anticholinergics can affect cardiac autonomic function of stable COPD patients.

关键词: 慢性阻塞性肺疾病; 噻托溴铵; 心率恢复

Key words: Chronic obstructive pulmonary disease; Tiotropium; Heart rate recovery

引用本文: 聂姗, 袁玮, 王浩彦, 徐秋芬, 贾楠. 吸入抗胆碱能药物对稳定期慢性阻塞性肺疾病患者运动后心率恢复的影响. 中国呼吸与危重监护杂志, 2018, 17(6): 544-547. doi: 10.7507/1671-6205.201805053 复制

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1. 文富强. 2017 年慢性阻塞性肺疾病全球创议再解读. 华西医学, 2018, 33(1): 23-27.
2. Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease (UPLIFT trial). N Engl J Med, 2008, 359(15): 1543-1554.
3. Gershon A, Croxford R, Calzavara A, et al. Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease. JAMA Intern Med, 2013, 173(13): 1175-1184.
4. Singh S, Loke YK, Enright P, et al. Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications. Thorax, 2013, 68(1): 114-116.
5. Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA, 2008, 300(12): 1439-1450.
6. Jardine DL, Charles CJ, Frampton CM, et al. Cardiac sympathetic nerve activity and ventricular fibrillation during acute myocardial infarction in a conscious sheep model. Am J Physiol Heart Circ Physiol, 2007, 293(1): H433-H439.
7. Passariello G, Peluso A, Moniello G, et al. Effect of autonomic nervous system dysfunction on sudden death in ischemic patients with anginal syndrome died during electrocardiographic monitoring in Intensive Care Unit. Minerva Anestesiol, 2007, 73(4): 207-212.
8. Cole CR, Blackstone EH, Pashkow FJ, et al. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med, 1999, 341(18): 1351-1357.
9. 刘海舰, 刘锦铭, 杨文兰, 等. 运动试验后心率恢复与稳定期慢性阻塞性肺疾病患者运动耐力的相关性研究. 中华全科医师杂志, 2013, 12(1): 34-39.
10. Hwangbo G, Lee DH, Park SH, et al. Changes in cardiopulmonary function according to posture during recovery after maximal exercise. J Phys Ther Sci, 2017, 29(7): 1163-1166.
11. Arena R, Myers J, Aslam SS, et al. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J, 2003, 41(6): 354-360.
12. Imai K, Sato H, Hori M, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol, 1994, 24(6): 1529-1535.
13. Chhabra SK, De S. Cardiovascular autonomic neuropathy in chronic obstructive pulmonary disease. Respir Med, 2005, 99(1): 126-133.
14. Lacasse M, Maltais F, Poirier P, et al. Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease. Respir Med, 2005, 99(7): 877-886.
15. 石萍, 喻洪流. 心率变异性的线性参数和非线性图形特征在自主神经功能评价中的应用研究. 生物医学工程学杂志, 2014, 31(2): 302-307.
16. Wang X, Jiang Z, Chen B, et al. Cardiac autonomic function in patients with acute exacerbation of chronic obstructive pulmonary disease with and without ventricular tachycardia. BMC Pulm Med, 2016, 16(1): 124.
17. Rodríguez DA, Kortianou EA, Alison JA, et al. Heart rate recovery after 6-min walking test predicts acute exacerbation in COPD. Lung, 2017, 195(4): 463-467.
18. Wu YK, Huang CY, Yang MC, et al. Effect of tiotropium on heart rate variability in stable chronic obstructive pulmonary disease patients. J Aerosol Med Pulm Drug Deliv, 2015, 28(2): 100-105.