静脉注射美托洛尔对肥厚型心肌病左心室功能的影响

Effect of Intravenous Metoprolol on Left Ventricular Function in Patients With Hypertrophic Cardiomyopathy

目的:应用频谱多普勒超声心动图技术,定量观测肥厚型梗阻性心肌病和肥厚型非梗阻性心肌病患者经静脉注射美托洛尔前后左心室功能和左心室流出道压力阶差的变化,并观察血流动力学的变化,探讨静脉注射美托洛尔对肥厚型心肌病左心室功能的影响。方法:应用PHILIPS-SONOS7500型彩色多普勒超声诊断仪,测量用药前和用药后10分钟肥厚型梗阻性心肌病组(n=33)和肥厚型非梗阻性心肌病组(n=26)患者左心室功能各指标,并监测用药过程中的血流动力学变化。结果:肥厚型梗阻性心肌病组患者用药后较用药前左心室舒张功能明显改善,左心室流出道(LVOT)明显增宽(P<0.05),左心室流出道压力阶差(LVOTPG)明显下降(P<0.05),EF值无明显变化(P>0.05);肥厚型非梗阻性心肌病组患者用药后较用药前上述各指标无明显变化(P>0.05)。两组的心率、收缩压、舒张压用药后较用药前均明显降低(P<0.05),有显著差异。结论:静脉注射美托洛尔能够快速改善肥厚型梗阻性心肌病组患者的左心室舒张功能,改善临床症状,明显减轻左心室流出道梗阻,降低压力阶差,明显降低两组的血压、心率,影响其血流动力学;而对肥厚型非梗阻性心肌病组患者无明显作用,对两组的收缩功能均无明显影响。

Objective： We quantitatively determined the changes of left ventricular （ LV ） diastolic and systolic function and LV outflow tract pressure gradient in patients with hypertrophic obstructive cardiomyopathy （ HOCM ） and hypertrophic nonobstructive cardiomyopathy （HNCM） by non-invasive pulsed wave Doppler techniques before and after intravenous metoprolol administration. Their hemodynamic indexes were measured and the acute effect of LV function was observed. Methods： LV function indexes were measured by color Doppler ultrasound diagnostic apparatus of PHILIPS-SONOS 7500, and the hemodynamics in patients with hypertrophic cardiomyopathy were detected before and 10 minutes after intravenous metoprolol adminstration. Results：Left ventricular diastolic function of patients with hypertrophic obstructive cardiomyopathy was markedly improved; E-point septal separation and the width of LV outflow tract were significantly ascended. LV outflow tract pressure gradient was significantly descended. Indexes of hypertrophic nonobstructive cardiomyopathy showed no significant difference ; ejection fraction of both groups had no significant changes ; the blood pressure and heart rate of both groups were significantly descended. Conclusion： Intravenous metoprolol can improve left ventricular diastolic function, significantly reduce LV outflow tract obstruction and descend LV outflow tract pressure gradient in patients with hypertrophic obstructive cardiomyopathy. No significant effect was observed in patients with hypertrophic nonobstructive cardiomyopathy. Intravenous metoprolol had no effect on systolic function in both groups, but it could significantly descend blood pressure and heart rate, and improve hemodynamics.