摘要
目的观察静脉使用美托洛尔(倍他乐克)治疗急性前壁心肌梗死患者的近期临床疗效和安全性。方法入选急性前壁心肌梗死患者362例,随机分为静脉组179例和口服组183例,静脉组静脉注射酒石酸美托洛尔5～15mg,继之口服25mg,每日2次;口服组直接给予口服制剂,25mg,每日2次。比较两组患者疗效,以及住院7天及3个月心脏不良事件和1个月心脏超声资料。结果与治疗前比较,口服组和静脉组的心率、收缩压和舒张压在治疗后1、6、12、24、48和72小时均呈逐渐下降趋势,但静脉组下降的更多,除了舒张压在两组间差异无统计学意义外,其他指标在组间、不同时点及组间和不同时点的交互作用差异均有统计学意义(P<0.05或<0.01);1个月随访,两组左心室射血分数(LVEF)均逐渐增加,但静脉组增加的幅度更大,口服组和静脉组在治疗前、治疗7天和治疗1个月分别为:LVEF(51.08±8.40)%、(53.18±8.06)%和(56.38±8.24)%vs(51.39±6.82)%、(55.70±5.92)%和(58.74±6.32)%,组间、不同时点、组间和不同时点交互作用差异均有统计学意义(P<0.05或<0.01);两组左心室舒张末期内径(LVDD)均逐渐缩小,LVDD(50.61±5.00)mm,(50.32±4.98)mm和(49.86±4.58)mm vs(50.56±4.15)mm、(49.72±3.97)mm和(49.63±4.03)mm,两组不同时点差异有统计学意义(P<0.01);治疗后7天两组心律失常和主要心脏不良事件差异有统计学意义,分别为25.7%(47/183)vs 14.0%(25/179),18.0%(33/183)vs 10.1%(18/179)(P<0.05或<0.01)。结论早期静脉应用美托洛尔可更有效改善血流动力学稳定的急性前壁心肌梗死患者的近期预后,而且不增加早期心力衰竭的风险。
Objective To observe the short-term patients with acute anterior myocardial infarction. Methods clinical efficacy and safety of intravenous metoprolol on 362 patients who suffered from acute anterior myocardial infarction were randomly divided into two groups：intravenous group （ n = 179） and oral group （ n = 183）. All patients were given conventional treatment, patients in intravenous group were injected metoprolol intravenously at doses of 5-15 mg and then treated with oral metoprolol 25 mg, twice daily,patients in oral group were treated with oral metoprolol,25 mg,twice daily. The clinical effectiveness including the incidence of adverse cardiac events during 7 days and 3 month follow-up and cardiac ultrasound data at one month were compared between two groups. Results Compared with before treatment,the heart rate, systolic blood pressure and diastolic blood pressure in both groups showed gradual declined trends at 1,6,12,24,48 and 72 hours after treatment, but the intravenous group deelined more, except the diastolic blood pressure had no significant difference between twe groups,the other indicators between the two groups, at different points,between the two groups and the interaction of different points in time differences were statistically significant（ P 〈0.05 or ± 0.01）, during 1 month follow-up period, left ventricutar ejection fraction （LVEF） in both groups all increased gradually, but the LVEF improvement in intravenous group was more remarkable, the LVEF in oral group and intravenous group before treatment, and treatment for 7 days and 1month was （51.08 ± 8.40）%, （53.18 ± 8.06） %, （56.38 ± 8.24 ） % vs （ 51.39 ± 6.82 ）%, （ 55.70 ± 5.92 ） %, （ 58.74 ± 6.32 ） %, between the two groups, at different points,between the two groups and the interaction of different points in time differences were statistically significant（ P 〈0.05 or 〈0. 01） ,left ventricular end-diastolic dimensi0n（LVDD） in both groups decreased gradually, （50.61±5.00） mm,（50.32±4.98） mm and （9.86＋4.58） mm vs （50.56±4.15） mm,（49.72±3.97） mm and （49.63 ±4.03） mm,the difference at different time points in two groups was statistically significant（ P 〈0.01）;the malignant arrhythmia and major adverse cardiac events in intravenous group were decreased markedly, 25.7 % （47/183） vs14.0%（25/179）,18.0%（33/183） vs 10.1%（18/179）（P〈0.05 or 〈0.01）. Conclusion The injection of metoprolol can effectively improve the short-term clinical effect without increasing heart failure in haemodynamically stable patients with acute anterior myocardial infarction.
出处
《临床荟萃》
CAS
2013年第1期26-29,32,共5页
Clinical Focus
关键词
心肌梗死
美托洛尔
预后
myocardial infarction
metoprolol
prognosis
