美托洛尔与依那普利对严重充血性心力衰竭室性心律失常作用的对比研究

A Comparative Study of Effect of Metoprolol and Enalapril on Ventricular Arrhythmia in Patients With Congestive Heart Failure

目的：观察美托洛尔（Ｍｅｔｏｐｒｏｌｏｌ）与依那普利（Ｅｎａｌａｐｒｉｌ）对严重充血性心力衰竭室性心律失常的影响。方法：对４２例充血性心力衰竭（ＮＹＨＡＩＩ～ＩＶ级）伴有室性心律失常患者，在强心利尿基础上随机给予美托洛尔（１２．５～２５．０ｍｇ／ｄ）或依那普利（５～４０ｍｇ／ｄ），治疗均为１６周。分别于治疗前后进行２４小时动态心电图监测与临床心功能评估。结果：治疗前美托洛尔与依那普利组２４小时室性心律失常总检出率及各类型（简单型、复杂型及室性心动过速）检出率均无明显差异（Ｐ均＞０．０５），治疗后２４小时室性心律失常总检出率美托洛尔组下降４８．７％，依那普利组下降１９．５％，二者比较差异有显著性（Ｐ＜０．０１）；复杂室性心律失常及室性心动过速检出率美托洛尔组分别下降７８．６％与１００．０％（Ｐ均＜０．０１），依那普利组仅分别下降２３．１％与１２．５％（Ｐ均＞０．０５）。两组患者心功能均获不同程度的改善。结论：美托洛尔与依那普利均可改善严重充血性心力衰竭患者心脏功能，而美托洛尔还同时具有干预高级别室性心律失常发生的特殊效应。

Objective:To observe the effect of metoprolol and enalapril on ventricular arrhythmia in patients with severe congestive heart failure. Methods:Forty two patients of ventricular arrhythmia(VA) with congestive heart failure (NYHA III IV) under conventional therapy were randomized to metoprolol (12 5 25 0 mg/d) or enalapril (5 40 mg/d) for 16 weeks.Before and after treatment VA was recorded by 24 hour ambulatory electrocardiographic monitoring and cardiac function was estimated by clinical symptoms and signs. Results:Before the treatment the incidences of VA in total and variant types were not significantly different between the two groups,while after the treatment the total incidence of VA in 24 h reduced by 48 7% and 19 5%( p <0 01) in the metoprolol and enalapril groups,respectively.The incidences of complex VA and ventricular tachycardia were reduced by 78 6% and 100%(all p <0 01),respectively in the metoprolol group,and only reduced by 23 1% and 12 5% (all p >0 05),respectively in the enalapril group.The improvment of cardiac function was similiar in both groups. Conclusion:Both metoprolol and enalapril could improve cardiac function,but only metoprolol could reduce the incidence of high class VA in patients with severe congestive heart failure.