美托洛尔在心房纤颤合并慢性心力衰竭治疗中的应用效果  

Application effect of metoprolol in the treatment of atrial fibrillation complicated with chronic heart failure

作　　者：苏凤婷[1] 严沛元 夏清[1] Su Fengting;Yan Peiyuan;Xia Qing(Department of Internal Medicine,the People's Hospital of Zhejiang Province,Hangzhou,Zhejiang 310024,China)

机构地区：[1]浙江省人民医院内科,杭州310024

出　　处：《中国基层医药》2019年第20期2442-2445,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨美托洛尔在心房纤颤(房颤)合并慢性心力衰竭(CHF)治疗中的应用效果.方法选择2015年2月至2019年2月浙江省人民医院望江山院区收治的房颤合并CHF的老年患者398例为研究对象,按照随机数字表法将患者分为两组,每组199例.对照组采用休息、吸氧、洋地黄、利尿剂、血管紧张素转换酶抑制剂、硝酸酯及肠溶阿司匹林等常规治疗.观察组在此基础上联合应用美托洛尔口服治疗,起始剂量为6.25 mg,每天2次,根据患者的状态进行药物用量的调整.两组疗程均为3个月.比较两组患者的治疗有效率、治疗前后的心率变化、左心室的射血分数和6 min步行距离.结果观察组有效率为88.94%(177/199),显著高于对照组的71.86%(143/199),差异有统计学意义(χ^2=18.433,P<0.05).观察组治疗后最高心率、最低心率和静息心率均显著优于对照组[(115.12 ±0.35)次/min比(122.12 ±16.22)次/min,(90.21 ± 18.12)次/min比(94.12 ±11.11)次/min,(97.00 ±9.64)次/min比(102.03 ±11.20)次/min],均差异有统计学意义(t=4.246、4.783、4.662,均P<0.05).观察组治疗后左心室的射血分数和6 min步行距离均显著优于对照组[(45.0 ±2.0)%比(41.0 ±3.0)%,(340.09 ±31.45)m比(302.43 ±29.45)m],均差异有统计学意义(t=4.246、7.662,均P<0.05).结论在洋地黄治疗基础上联合美托洛尔进行治疗,有效控制房颤合并CHF的心率,提高心室功能,增加心脏耐力,该联合用药治疗方法值得推广.Objective To investigate the application effect of metoprolol in the treatment of atrial fibrillation complicated with chronic heart failure(CHF). Methods From February 2015 to February 2019, 398 elderly patients with atrial fibrillation and CHF in Wangjiangshan Branch of the People's Hospital of Zhejiang Province were selected in the study.The patients were divided into two groups according to the digital table, with 199 case in each group.The control group was treated with rest, digitalis inhalation, diuretics, angiotensin converting enzyme inhibitors, nitrate and enteric-coated aspirin.The observation group was treated with metoprolol on this basis.The effective rate of treatment, heart rate changes before and after treatment, left ventricular ejection fraction and 6-minute walking distance in the two groups were observed and analyzed. Results The effective rate of the observation group was 88.94%(177/199), which was significantly higher than 71.86%(143/199) in the control group, the difference was statistically significant (χ2=18.433, P=0.000). The highest heart rate, the lowest heart rate and the resting heart rate in the observation group after treatment were significantly better than those in the control group[(115.12±0.35)times/min vs.(122.12±16.22)times/min,(90.21±18.12)times/min vs.(94.12±11.11)times/min,(97.00±9.64)times/min vs.(102.03±11.20)times/min], the differences were statistically significant(t=4.246, 4.783, 4.662, all P<0.05). The LVEF and 6-minute walking distance of the observation group after treatment were significantly better than those of the control group[(45.0±2.0)% vs.(41.0±3.0)%,(340.09±31.45)m vs.(302.43±29.45)m], the differences were statistically significant(t=4.246, 7.662, all P<0.05). Conclusion Digitalis combined with metoprolol can effectively control the heart rate of atrial fibrillation combined with CHF, improve ventricular function and increase cardiac endurance.The combined therapy is worthy of promoting in this disease.

关 键 词：心力衰竭 心房颤动 洋地黄属 美托洛尔 心率 每搏输出量 

分 类 号：R541.6[医药卫生—心血管疾病]