美托洛尔对缺血性心脏病心力衰竭患者心室重塑和心功能的影响  

The effects of metoprolol therapy on the left ventricular remodeling and function in the patients of ischemic heart disease with cardiac dysfunction

作　　者：高丽君[1] 刘坤申[1] 王进华[1] 彭应心[1] 李延辉[1] 王小平[1] 

机构地区：[1]河北省人民医院内二科,石家庄市050051

出　　处：《中华心血管病杂志》2001年第12期746-749,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨美托洛尔对缺血性心脏病心力衰竭患者心室重塑及心功能的影响。方法缺血性心脏病心力衰竭患者 80例 ,左室射血分数≤ 45 % ,心功能 (NYHA)Ⅱ Ⅳ级 ,常规治疗基础上随机分为治疗组和对照组。治疗 6个月 ,观察美托洛尔对心室重塑、心功能的影响。应用心脏彩色超声仪测定基线值及 1个月、3个月、6个月左室结构及功能指标变化。结果　美托洛尔平均用量为 (39 8± 13 8)mg/d。经过 6个月治疗 ,美托洛尔治疗组症状和心功能改善 ,与对照组比较左室射血分数上升 [(4 8 1± 2 5 ) %vs(39 5± 2 74) % ,P =0 0 0 2 ]、左室收缩末容积下降 [(16 3 5 0± 45 0 0 )mlvs (181 10± 44 0 0 )ml,P =0 0 42 ];与基线比较左室舒张末容积下降 (P <0 0 5 ) ;但两组间尚无统计学差异。结论　在强心、利尿、血管紧张素转化酶抑制剂基础上 ,应用美托洛尔能显著改善缺血性心脏病心力衰竭患者的心功能 ,改善心室重塑。长期应用可改善衰竭心脏心肌细胞的生物学效应 。Objective To investigate cardiac function improvement and remodeling process with titrated metoprolol therapy in the patients of coronary artery disease with cardiac dysfunction. Methods In 80 patients with cardiac dysfunction, the ejection fraction of them was ≤0.45. On a basic medical therapy including digitalis, diuretics and ACEI, they were divided randomly into metoprolol group and control group for a 6-month follow-up period. The data of ventricular function were measured by 20-echocardiography at baseline, 1,3 and 6 months after admission. Results The mean dose of metoprolol was titrated to 39.8±13.8mg/day (range 18.75 to 75mg/d). In metoprolol group symptom scores and NYHA class improved, as reflected by the increased left ventricular ejection fraction (48.10±2.50) vs (39.50±2.74) (P=0.002) and the decreased left ventricular end systolic volume (163.50±45.00) vs (181.40±44.00) (P=0.042) compared with those in control group. Moreover, in treatment group, the left ventricular end-diastolic volume decreased at 6-month compared with that at baseline (P<0.05), but there was no significant differences between the two groups. Conclusion Based on the medication of digitalis, diuretics and angiotensin-converting enzyme inhibitors, metoprolol therapy can improve left ventricular performance, reverse LV remodeling in patients of coronary artery disease with heart failure and also improve the biological properties of the chronically failing heart. There was no difference of this benefit in the patients with different NYHA classes.

关 键 词：美托洛尔 心肌缺血 充血性心力衰竭 心室重塑 

分 类 号：R541.6[医药卫生—心血管疾病]