急性心肌梗死早期静脉及口服应用美托洛尔对心率变异性的干预作用  

Effect of early intravenous then oral use of metoprolol on heart rate variability for after acute myocardial infarction

作　　者：苏瑞瑛[1] 陈亚丽[1] 赵娟[2] 王永辉[3] 殷洪山[1] 肖文良[1] 孙平[1] 王治乾[1] 

机构地区：[1]河北医科大学第三医院心血管内科,河北石家庄050051 [2]河北医科大学细胞生物学教研室,河北石家庄050017 [3]河北师范大学学生处,河北石家庄050016

出　　处：《临床荟萃》2009年第7期571-574,共4页Clinical Focus

摘　　要：目的观察早期静脉注射和口服美托洛尔后对急性心肌梗死(AMI)心率变异性(HRV)的影响,并评估其安全性。方法53例AMI患者随机分成治疗组(美托洛尔组)27例,安慰剂组26例,2组均接受AMI常规治疗,美托洛尔组首先静脉注射美托洛尔5 mg,共3次,然后口服美托洛尔每日200 mg;安慰剂组给予安慰剂,静脉及口服方法与治疗组给药方式相同,入组后24小时及出院前分别记录2组24小时动态心电图。结果AMI后24小时内2组HRV指数、房性和室性期前收缩的例数差异无统计学意义;出院前美托洛尔组的全部窦性心搏R-R间期标准差、R-R间期平均值的标准差、R-R间期差值的均方根和心率变异三角指数均比美托洛尔组发病24小时数和安慰剂组出院前24小时明显提高(P<0.05或<0.01);出院前24小时美托洛尔组房性和室性期前收缩的例数明显少于安慰剂组15(55.6%)vs 21(80.8%)和11(40.7%)vs 19(73.1%)(均P<0.01)。结论AMI早期静脉及口服美托洛尔可有效提高HRV,抑制AMI后发生的房性和室性心律失常,但应在血流动力学稳定后开始使用,以避免增加心源性休克的风险。Objective To observe the effect of early intravenous then oral metoprolol in patients with heart rate variability（HRV） after acute myocardial infarction（AMI）,and to evaluate the safety. Methods Randomised placebocontrolled double-blind trial was designed. The treatment group （metoprolol group） consisted of 27 cases, on the basis of the routine treatment of AMI,adopted metoprolol 5 mg three times by intravenous injection, then oral metoprolol 200 mga day. One placebo-controlled group consisted of 26 cases, beside accepting conventional therapy of AMI, simultaneously intravenous then oral placebo. The method was same as treatment group. For the patients, dynamic electrocardiogram was recorded after entering group and in prior to discharge. Results HRV index and the cases of development of atrial and ventricular premature beats within 24 hours after AMI were no statistic significance. But before discharge,standard deviation of all normal sinus R-R intervals over 24 hours,standard deviation of the averaged normal sinus R-R intervals for all 5-minute segments over 24 hours,root mean square of the successive normal sinus R-R intervals difference over 24 hours, heart rate variability triangular index were obviously higher in treatment group than in placebo-controlled group （P 〈 0.05 or 〈0.01）. Before discharge, the cases of development of atrial and ventricular premature beats were obviously lower in treatment group than in placebo-controlled group 15 （55.6%） vs 21 （80.8%） ,11 （40.7%） vs 19 （73.1%） （all P〈0.01）. Conclusion Early intravenous then oral metoprolol has a powerful effect on HRV after AMI. But the patients should take meotoprolol when their haemodynamics are stabilized to avoid the risk of cardiac shock.

关 键 词：心肌梗死 心率 自主神经系统 美托洛尔 

分 类 号：R541.41[医药卫生—心血管疾病]