艾司洛尔对急性心肌梗死再灌注心律失常的影响  

Effect of esmolol on reperfusion arrhythmia in patients with acute myocardial infarction

作　　者：张倩[1] 王春梅[1] 张立新[1] 朱小玲[1] 李响[1] 刘子军[1] 

机构地区：[1]首都医科大学附属北京安贞医院抢救中心,北京市100029

出　　处：《中华实用诊断与治疗杂志》2010年第12期1179-1181,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的：观察艾司洛尔对急性心肌梗死再灌注心律失常的影响。方法：急性ST段抬高心肌梗死（发病12 h内）并接受再灌注治疗患者622例（溶栓治疗103例,直接冠状动脉介入治疗519例）,观察组（228例）于入院诊断明确后及再灌注治疗期间静脉或口服应用予艾司洛尔,对照组（394例）再灌注前或再灌注时不应用任何β受体阻滞剂,其他治疗同观察组,比较2组再灌注时心律失常发生率及对心率、血压的影响。结果：观察组再灌注时室性期前收缩、室性加速性自主心律、室性心动过速、心室颤动,心房早搏、心房纤颤等心律失常发生率明显低于对照组,差异有统计学意义（P〈0.05）。多因素分析结果显示应用艾司洛尔（OR=2.343,95%CI：0.998~3.247,P=0.035）是再灌注过程中发生室性心动过速、心室颤动及住院期间病死率的独立影响因素（OR=1.687,95%CI：1.006~4.034,P=0.009）。结论：超短效β受体阻滞剂艾司洛尔能显著减少再灌注心律失常,在急性心肌梗死再灌注损伤过程中起重要保护作用,安全有效,改善急性心肌梗死预后。Objective To investigate the effect of esmolol on myocardial ischemia reperfusion arrhythmia in patients with acute myocardial infarction.Methods In 622 patients with ST-elevation myocardial infarction,103 received thrombolysis therapy and 519 received coronary artery interventional therapy.The esmolol group received an esmolol infusion as soon as the patients were diagnosed acute myocardial infarction.Control group was not given β-blockade before or during reperfusion treatment.The influences of reperfusion arrhythmia on heart rate and blood pressure were compared between two groups.Results The incidence rates of ventricular premature,accelerated idioventricular rhythm,ventricular tachycardia,ventricular fibrillation,atrial premature and atrial fibrillation were obviously lower in esmolol group than those in control group,which showed significant differences between two groups（P0.05）.Multivariate analysis showed that esmolol was an independent risk factor for ventricular tachycardia,ventricular fibrillation and in-hospital fatality rate（OR=1.687,95%CI：1.006 to 4.034,P=0.009）.Conclusion Treatment with esmolol can reduce the reperfusion arrhythmia and plays an important role in protecting reperfusion injury in acute myocardial infarction.It is safe and effective,and can improve the prognosis of acute myocardial infarction.

关 键 词：急性心肌梗死 再灌注心律失常 艾司洛尔 

分 类 号：R542.22[医药卫生—心血管疾病]