美托洛尔对慢性阻塞性肺疾病合并急性心肌梗死患者心肺功能和心血管不良事件的影响

Effects of metoprolol on cardiopulmonary function and adverse cardiovascular events in patients with chronic obstructive pulmonary disease complicated with acute myocardial infarction

目的:探讨美托洛尔对慢性阻塞性肺疾病(COPD)合并急性心肌梗死(AMI)患者心肺功能及不良心血管事件的影响。方法:采用随机编号法将本院2015-12-2017-12收治的60例COPD合并AMI患者分为观察组与对照组,每组30例。两组患者均接受美托洛尔治疗,对照组初始剂量12.5 mg/d,逐渐增加至25 mg/d且维持该剂量;观察组初始剂量12.5 mg/d,逐渐增加至目标剂量,最大剂量200 mg/d及以下。治疗半年后评价两组患者药物不良反应及不良心血管事件发生率,测定记录两组治疗前及治疗半年后心肺功能,包括心率(HR)、收缩压(SBP)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、肺动脉压(PAP)、1秒用力呼气量(FEV1)及血氧饱和度(SaO2),且记录治疗1、3、6个月6分钟步行距离试验(6MWT)结果。结果:与治疗前比较,两组患者治疗半年后HR、SBP、LVEDD、LVESD及PAP水平均显著下降,LVEF、FEV1、SaO2水平均显著上升,且观察组下降或上升幅度较对照组更明显(SaO2除外)(均P<0.05)。观察组治疗3、6个月6MWT距离均显著长于对照组(均P<0.05)。两组药物不良反应发生率比较差异无统计学意义。观察组治疗6个月不良心血管事件发生率10.00%,低于对照组的26.67%,但差异无统计学意义。结论:目标剂量美托洛尔能明显改善COPD合并AMI患者心肺功能,且不增加药物不良反应发生率,有效减少不良心血管事件发生。

Objective:To investigate the effect of metoprolol on cardiopulmonary function and adverse cardiovascular events in patients with chronic obstructive pulmonary disease(COPD)complicated with acute myocardial infarction(AMI).Method:Sixty patients with COPD complicated with AMI who were admitted to the hospital from December 2015 to December 2017 were randomly divided into observation group and control group,with 30 cases in each group.All patients were initiated with12.5 mg/d of metoprolol,and the doses wereup-titratedto25 mg/din the control group and 200 mg/d orless of the target dose in the observation group.After six months of treatment,the incidence of adverse drug reactions and adverse cardiovascular events were evaluated.The cardiopulmonary function including heart rate(HR),systolic blood pressure(SBP),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),pulmonary arterial pressure(PAP),forced expiratory volume in 1 second(FEV1)and oxygen saturation(SaO2)in both groups before and after six months of treatment were measured and recorded.The results of 6 minutes walk test(6 MWT)after 1 month,3 months and 6 months of treatment were recorded.Result:After six months of treatment,HR,SBP,LVEDD,LVESD and PAP in both groups decreased significantly,while LVEF,FEV1 and SaO2increasedsignificantly.Importantly,these changes weremore significantin the observation group than in the control group(except SaO2)(all P<0.05).The 6 MWT distances in observation group was significantly longer than thatin control group after 3 and 6 months of treatment(both P<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups.The incidence of adverse cardiovascular events in observation group was lower than that in control group after 6 months of treatment(10.00%vs 26.67%).Conclusion:In patients with COPD and AMI,target dose of metoprolol may improve cardiopulmonary function and reduce adverse cardiovascular eventswith no increased adverse drug reactions.