快速滴定法加量美托洛尔治疗急性心肌梗死的疗效  

Therapeutic effect of increasing dose of metoprolol by rapid titration method on acute myocardial infarction

作　　者：陈少伟 孙智山 黄河 吴名星 周贻 

机构地区：[1]湘潭中心医院心内科,湖南湘潭411100

出　　处：《心血管康复医学杂志》2014年第4期443-446,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:观察常规加量法及快速滴定法加量美托洛尔治疗急性心肌梗死(AMI)的疗效。方法:将发病24h内诊断为AMI且无美托洛尔禁忌证的住院患者60例随机分成两组,在常规治疗的基础上采用不同方法给予美托洛尔,常规加量组采用7d加量法,快速滴定组采用3d加量法,两组均在达目标剂量190mg/d后,以此量维持之,观察两组的疗效。结果:1在随访期间,两组均无患者再发心肌梗死、心衰而再次住院治疗,没有出现猝死等现象;23月后门诊行心脏超声检查,与常规加量组比较,快速滴定组左室舒张末内径[LVEDd,(55.00±7.56)mm比(50.00±5.81)mm]显著降低(P<0.01),左室射血分数[LVEF,(49.13±10.18)%比(57.84±10.34)%]显著升高(P<0.01)。结论:快速滴定法可以更早达到患者美托洛尔的目标量,更早抑制肾素释放,阻断肾素-血管紧张素系统,改善心肌重构和心功能。Objective：To observe and compare the therapeutic effect of metoprolol by routine increasing dose method and rapid titration method on acute myocardial infarction （AMI）.Methods：A total of 60 inpatients,who were di-agnosed with AMI within 24h and without contraindications for metoprolol,were randomly divided into two groups：routine therapy group （received metoprolol using routine methods,the dose was added in seven days）and rapid ti-tration group （metoprolol was added in three days using titration）.The dosage maintained with 190 mg/d after both groups reaching the target dose of 190mg/d;then therapeutic effects were observed in both groups.Results： ①There were no re-myocardial infarction,rehospitalization caused by heart failure and sudden death etc.in both groups;② Patients received echocardiography in outpatients after three months.Compared with routine increasing dose group,there was significant reduction in left ventricular end-diastolic diameter [LVEDd,（55.00±7.56）mm vs.（50.00± 5.81）mm]and significant rise in left ventricular ejection fraction [LVEF,（49.13 ± 10.18）% vs. （57.84±10.34）%]in rapid titration group,P 〈0.01 both.Conclusion：Rapid titration method could make the pa-tients rapidly reach the targeted dose of metoprolol and inhibit renin release earlier,block the renin-angiotensin sys-tem,and improve myocardial remodeling and cardiac function.

关 键 词：滴定分析法 心肌梗塞 美托洛尔 

分 类 号：R542.22[医药卫生—心血管疾病]