门冬氨酸钾镁联合美托洛尔、胺碘酮对心肌梗死合并心律失常患者的临床疗效

Clinieal Effects of Potassium Magnesium Aspartate Combined with Metoprolol and Amiodarone in the Treatment of Patients with Myocardial Infarction and Arrhythmia

目的:探讨门冬氨酸钾镁联合美托洛尔、胺碘酮对心肌梗死合并心律失常患者血液动力学、血清磷酸肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平的影响.方法:将我院2014年5月—2017年5月收治的185例急性心肌梗死(AMI)合并室性心律失常(VA)患者按治疗方法不同分为A组(95例)和B组(90例),A组给予门冬氨酸钾镁注射液(40 mL+5% 葡萄糖注射液250 mL,ivgtt,qd)+注射用盐酸胺碘酮(首次剂量为0.15 g,ivgtt)+酒石酸美托洛尔片(起始剂量为12.5~25 mg,bid,可酌情增加剂量,最高剂量为25~50 mg)治疗,B组仅给予酒石酸美托洛尔片治疗,比较两组疗效及治疗前后血液动力学、血清CK-MB、cTnI水平等的变化.结果:治疗后,A组临床疗效优于B组,病死率低于B组,差异有统计学意义(P<0.05);治疗后A组心率、QT离散度(QTd)、血液动力学指标低于B组,左室射血分数(LVEF)和QTc高于B组,差异有统计学意义(P<0.05);治疗后A组血清CK-MB、cTnI、可溶性血管细胞黏附分子(sICAM)-1水平均低于B组,差异有统计学意义(P<0.05).结论:门冬氨酸钾镁联合美托洛尔、胺碘酮可有效改善心肌梗死合并心律失常患者的血液动力学状况,降低血清CK-MB、cTnI、sVCAM-1水平,降低病死率.

Objective:To investigate the effect of potassium magnesium aspartate combined with metoprolol and amiodarone on the levels of hemodynamics,serum phosphocreatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI)in patients with myocardial infarction and arrhythmia.Methods:185 patients with acute myocardial infarction(AMI)and ventricular arrhythmia(VA)admitted to our hospital from May 2014 to May 2017 were divided into a group A(95 cases)and a group B(90 cases)according to different treatment methods.The patients in the group A were treated with potassium magnesium aspartate(40 mL+5%glucose injection 250 mL,ivgtt,qd)+amiodarone hydrochloride for injection(first dose:0.15 g,ivgtt)+tartaric acid metoprolol tartrate tablets(initial dose:12.5~25 mg,bid,which could be increased as appropriate,the highest dose:25~50 mg).The patients in the group B were treated with metoprolol tartrate tablets alone.The efficacy and the changes in hemodynamics and serum CK-MB and cTnI levels before and after treatment were compared between the two groups.Results:After treatment,the clinical efficacy in the group A was better than that in the group B,and the mortality rate was lower than that in group B,with statistically significant differences(P<0.05).After treatment,the heart rate,QT dispersion(QTd)and hemodynamic indexes in the group A were lower than those in the group B,and the left ventricular ejection fraction(LVEF)and QTc were higher than those in the group B,with statistically significant differences(P<0.05).After treatment,the serum levels of CK-MB,cTnI and soluble vascular cell adhesion molecule(sICAM)-1 in the group A were lower than those in the group B,with statistically significant differences(P<0.05).Conclusion:Potassium magnesium aspartate combined with metoprolol and amiodarone can effectively improve the hemodynamic status of the patients with myocardial infarction and arrhythmia,reduce serum CK-MB,cTnI and sVCAM-1 levels and decrease mortality.