扩张型心肌病并发充血性心力衰竭停用β受体阻滞剂后的临床不良反应观察

Clinical adverse reactions for stopping beta-receptor blocker in patients with dilated cardiomyopathy

目的:观察扩张型心肌病(DCM)并发充血性心力衰竭(CHF)患者停止美托洛尔治疗后的临床不良反应。方法:对64例服用美托洛尔≥18个月、心功能Ⅰ～Ⅱ级、无恶性室性心律失常及快速性心律失常的患者进行停药后的临床观察,随访期6个月。结果:7例(10.9%)发生心源性猝死,6例(9.4%)出现快速性室上性心律失常,17例(26.6%)心功能恶化至Ⅲ～Ⅳ级住院治疗;停药前、停药后3个月及6个月时的LVEF为(31.2±3.0)%、(46.3±4.3)%及(38.7±7.6)%。结论:DCM并发CHF的患者服用β受体阻滞剂后停用会出现猝死、心力衰竭恶化、快速性心律失常等不良临床后果,LVEF呈先升高后降低现象,如无停药的指征,DCM并发CHF患者长期甚至终身服用β受体阻滞剂非常必要。

Objective：To observe clinical adverse reactions in patients of dilated cardiomyopathy （DCM） with congestive heart failure（CHF） who have stopped taking beta-receptor blocker. Method：The 64 cases of DCM who, with NYHA function grade Ⅰ- Ⅱ , without malignant ventricular arrhythmias and rapid ventricular arrhythmias, stopped beta-receptor blocker and were analyzed in the study. Result： Seven cases （10. 9%） developed to sudden cardiac death; 6 cases （9.4 % ） led to supraventricular arrhythmias; Cardiac functions of 17 cases （26.6% ） deteriorated to grade Ⅲ - Ⅳ and need to be hospitalized. Their LVEF appeared （31.2±3.0）%, （46.3±4.3） %, （38. 7 ±7. 6）%, respectively corresponding to 3 months before, 3 months after and 6 months after taking betocloc. Conclusion：Patients of DCM with C HF who stopped beta-receptor blockers led to severe clinical adverse reactions, such as sudden death, heart failure deterioration, rapid cardiac arrhythmias. It is necessary that DCM patients should take the beta-receptor blocker for long or through all their lives if there are no contraindications.