从BISO-CAD研究看静息心率与不良心血管事件的相关性

2017-10-09 杨新春 国际循环

大量研究证实,心率加快与心血管疾病的发生发展密切相关。而β受体阻滞剂作用机制之一即可减慢心率,是控制心率的一类重要药物。围绕心率加快的机制和危害以及β受体阻滞剂在其管理中的作用,《国际循环》邀请首都医科大学附属北京朝阳医院杨新春教授进行了分析,并介绍其所参与的BISO-CAD研究重要发现及临床意义。

大量研究证实,心率加快与心血管疾病的发生发展密切相关。而β受体阻滞剂作用机制之一即可减慢心率,是控制心率的一类重要药物。围绕心率加快的机制和危害以及β受体阻滞剂在其管理中的作用,本文章邀请首都医科大学附属北京朝阳医院杨新春教授进行了分析,并介绍其所参与的BISO-CAD研究重要发现及临床意义。心率加快发生的机制及其危害自主神经功能失衡是心率加快的主要原因。心率加快作为交感神经过度激活的标志,可通过各种病理生理机制参与并促进心血管事件的发生。心率增快可致心肌耗氧量增加,同时因心脏舒张期明显缩短可减少左室充盈时间及冠状动脉灌注时间。前者造成心排出量下降,后者则影响心肌血供。心率增快除影响心脏血供,还可增加血流剪切应力,对血管造成损害,促进粥样斑块形成,甚至诱发动脉粥样斑块破裂。β受体阻滞剂在冠心病防治中的作用β受体阻滞剂在冠心病防治方面起着重要作用,其主要作用机制是通过选择性地结合β肾上腺素能受体,竞争性、可逆性拮抗β肾上腺素能物质对各器官的作用,减慢心率,减弱心肌收缩力,降低血压,减少心肌耗氧量,防止儿茶酚胺对心脏的损害,抗心律失常,预防心源性猝死,改善心室和血管的重塑及功能。除此之外,

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    2018-09-02 neurowu
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createdBy=b53a29082458, createdName=neurowu, createdTime=Sun Sep 02 21:03:00 CST 2018, time=2018-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1837348, encodeId=62b2183e3482d, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sun Nov 05 16:03:00 CST 2017, time=2017-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254697, encodeId=17a925469e9a, content=不错的文章值得一读., beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Sat Oct 21 00:05:01 CST 2017, time=2017-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252960, encodeId=7d96252960f5, content=:很好的文章.可以了解不少东西., beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Sun Oct 15 00:27:03 CST 2017, time=2017-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252514, encodeId=d17425251438, content=好好吧好好学习天天向上好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Fri Oct 13 10:24:27 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252128, encodeId=b0422521280d, content=谢谢分享!学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160916/IMG57DBEDBBA66BD2947.jpg, createdBy=3b181951777, createdName=ren1mw, createdTime=Thu Oct 12 06:45:33 CST 2017, time=2017-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251967, encodeId=678725196ea3, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Wed Oct 11 15:33:59 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579026, encodeId=0f2015e902638, content=<a href='/topic/show?id=3007990e6f0' target=_blank style='color:#2F92EE;'>#静息心率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99076, encryptionId=3007990e6f0, topicName=静息心率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=692416492771, createdName=12498761m61暂无昵称, createdTime=Wed Oct 11 10:03:00 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251886, encodeId=dfb82518863d, content=不会后悔好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Wed Oct 11 08:23:36 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-10-21 明天会更好!

    不错的文章值得一读.

    0

  5. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Wed Oct 11 15:33:59 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579026, encodeId=0f2015e902638, content=<a href='/topic/show?id=3007990e6f0' target=_blank style='color:#2F92EE;'>#静息心率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99076, encryptionId=3007990e6f0, topicName=静息心率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=692416492771, createdName=12498761m61暂无昵称, createdTime=Wed Oct 11 10:03:00 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251886, encodeId=dfb82518863d, content=不会后悔好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Wed Oct 11 08:23:36 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-10-15 明天会更好!

    :很好的文章.可以了解不少东西.

    0

  6. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Wed Oct 11 08:23:36 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-10-13 zwjnj2

    好好吧好好学习天天向上好

    0

  7. 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    2017-10-12 ren1mw

    谢谢分享!学习一下

    0

  8. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Wed Oct 11 15:33:59 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579026, encodeId=0f2015e902638, content=<a href='/topic/show?id=3007990e6f0' target=_blank style='color:#2F92EE;'>#静息心率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99076, encryptionId=3007990e6f0, topicName=静息心率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=692416492771, createdName=12498761m61暂无昵称, createdTime=Wed Oct 11 10:03:00 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251886, encodeId=dfb82518863d, content=不会后悔好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Wed Oct 11 08:23:36 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-10-11 三生有幸9135

    学习一下谢谢分享

    0

  9. 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  10. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Wed Oct 11 08:23:36 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-10-11 2227437833_79976374

    不会后悔好的

    0

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1976年唐山大地震,在历史留下了浓浓的一笔。开滦总医院吴寿岭和河北医科大学第一医院学者联合进行的研究发现,虽然时间过去40余年,但对经历者的健康还有所影响。研究显示,那些经历过唐山大地震的受试者,其平均静息心率、总胆固醇和空腹血糖水平比未经历过者要高,并且与地震中是否有亲人丧失无关。不过对甘油三酯水平无影响。进一步分析显示,大地震主要影响现在已40岁以上男性,而且这种影响取决于地震发生时的年纪大

ATVB:血压和心率与隐匿性脑梗塞与脑白质疏松症的恶化风险增加相关!

由此可见,升高的平均收缩压与隐匿性脑梗塞的风险增加相关,而平均舒张压升高与脑白质疏松症恶化的风险增加相关。这些发现强调了高血压在无症状脑血管病发病中的重要性,但它们之间的病理生理关系可能不同。

Diabetes Care:维格列汀和二甲双胍对小肠输注葡萄糖的2型糖尿病患者血压和心率的反应有啥影响?

由此可见,在2型糖尿病患者十二指肠葡萄糖输注过程中,维格列汀降低BP和增加HR,而二甲双胍增加HR,但并不影响BP。在肠内营养期间这些不同的心血管效应可能对餐后低血压有影响。

Crit Care Med:心脏手术后心输出量的心率修正!

超声心动图引导的心率优化可以显著增加心脏输出,相比于术后的临床衍生的起搏设置。最佳心率应根据每个病人实现个体化,总的等容时间是灵敏度最高的超声心动图指标来确定最佳的血流动力学。