美托洛尔对伴长RR间期的持续性心房颤动患者的影响  

Effect of metoprolol on long RR interval during atrial fibrillation

作　　者：崔晶[1] 董建增[1] 杜昕[1] 闫倩[1] 宁曼[1] 徐霞[1] 蒋晨曦[1] 康俊萍[1] 刘小慧[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科/房颤中心,北京100029

出　　处：《中国心脏起搏与心电生理杂志》2012年第5期389-393,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的评价美托洛尔在伴长RR间期(RR间期>1.5 s)的持续性心房颤动(简称房颤)患者中应用的疗效及安全性。方法 100例持续性房颤伴RR间期>1.5 s的患者,采用美托洛尔25 mg每日2次,治疗2周。观察治疗前后24 h和清醒状态时有RR间期≥2.5 s的患者比率,最长RR间期、平均心室率、最大心室率、最小心室率及心率变异性(HRV)的时域参数[24 h RR间期均值的标准差(SDNN)、相邻RR间期差值均方根(RMSSD)]和频域参数[高频(HF)、低频成分(LF)]。结果除3例自发转复为窦性心律,1例应用地高辛,1例失访外,最终入选95例。治疗后,最长RR间期从2 200±540(1 500～3 520)ms延长到2 400±490(1 510～3 560)ms(P<0.001);平均心室率、最大心室率、最小心室率均显著降低(79.78±13.31次/分vs 93.67±15.74次/分,151.82±25.08次/分vs 175.64±24.32次/分,40.78±9.79次/分vs 47.04±11.49次/分,P均<0.01);SDNN、RMSSD、HF和LF均显著增加(233.9±40.8 ms vs 209.7±54.2 ms,270.1±74.0 ms vs 240.2±40.8 ms,18 572.2±6 667.4 ms2 vs 13 997.0±5 491.3 ms2,11 373.7±4 486.6 ms2 vs 8 599.4±3 669.3 ms2,P均<0.01);全天有RR间期≥2.5s的患者,治疗前后无差异[36.8%(35/95)vs 28.4%(27/95),P>0.05];清醒状态有RR间期≥2.5 s的患者,治疗后较治疗前无明显增多[8.4%(8/95)vs 6.3%(6/95),P>0.05]。无近似晕厥及晕厥等不良事件发生。结论对于有β受体阻滞剂适应证伴有长RR间期的持续性房颤患者,口服美托洛尔仍然是安全有效的。Objective To elucidate the impact of metoprolol in atrial fibirllation（AF） patients with long RR intervals. Methods One hundred consecutive patients with persistent AF, and longest RR interval 〉 1.5 s were enrolled. Before and after 2 weeks＇ treatment with metoprolol（ at a dose of 25 mg twice daily）, the incidence of awake episodes, the proportion of patients with clinically significant pause, longest RR interval, maximum, minimum and mean ventrieular rate, as well as parameters of heart rate variability（HRV） included SD of all normal RR intervals （SDNN） , root mean square successive difference （RMSSD） , and spectral power in the high-frequency （HF） and low-frequency （LF）bands were measured by Hoher recordings. Results Ninety-five patients were enrolled in this study with the other 5 excluded due to termination of atrial fibrillation spontaneously（ n = 3 ）, adding digitalis （ n = 1 ） and out of eontaction （ n = 1 ） during treatment with metoprolol. Two weeks after treatment with metoprolol, the longest RR interval was increased from 2200 ± 540 ms to 2400 ± 490 ms（P 〈 0. 001 ） , the maximum ventricular rate, the minimum ventricular rate and the mean ventricular rate decreased signieantly（ 175.64 ± 24.32 beats/rain to 151.82 ± 25.08 beats/min, 47.04 ± 11.49 beats/min to 40.78 ± 9.79 beats/min, 93.67 ± 15.74 beats/min to 79.78 ± 13.31beats/min, all P 〈0. 01 ）. And SDNN, RMSSD, HF and LF was significantly increased （209.7 ± 54.2 ms to 233.9 ± 40.8 ms, 240.2 ± 40.8 ms to 270.1 ± 74.0 ms, 13 997.0 ± 5 491.3 ms2 to 18 572.2 ± 6 667.4 ms：, 8 599.4 ± 3 669.3 ms2 to 11 373.7 ±4 486.6 ms：, all P 〈 0.01）. However, the incidence of awake episodes of clinically significant pauses were similar between before and after metoprolol use [ 6. 3% （6/95） vs 8.4% （8/95）, P 〉 0.05 ], and so did the proportion of patients with RR interval ≥2.5 s [ 28.4% （27/95） vs 36.8 % （35/95）, P 〉 0.05 ]. No symptom related to bradycardia or ventri

关 键 词：心血管病学 持续性心房颤动 长RR间期 心室率控制 美托洛尔 

分 类 号：R541.75[医药卫生—心血管疾病] R540.41[医药卫生—内科学]