静脉注射美托洛尔治疗急性心肌梗死疗效评价

The Evaluation on the Therapeutic Effect of Intravenous Metoprolol on Patients with Acute Myocardial Infarction

目的观察静脉注射美托洛尔治疗急性心肌梗死(AMI)的疗效及安全性。方法对已确诊的80例急性心肌梗死患者随机分为治疗组与对照组,两组患者入选后均常规给予重组组织型纤溶酶原激活剂(r-tPA)100万U静脉溶栓、硝酸甘油静脉滴注、低分子肝素(LMWH)皮下注射、口服阿司匹林等治疗,治疗组住院后立即给予静脉注射美托洛尔针剂15mg,分3次,每次间隔5min,静脉注射完成15min后,开始口服美托洛尔,每6h1次,每次50mg,连续3个月。对照组给口服美托洛尔,每12h1次,每次6.25mg,第2周增至12.5mg,每12h1次,于第3周增至25mg,每12h1次,连续3个月,对两组疗效进行对照分析。结果治疗组较对照组病死率及快速性心律失常发生率均显著下降(P<0.01),房室传导阻滞(A-VB)发生率无显著性差异(P>0.05)。结论急性心肌梗死病人早期、足量使用美托洛尔安全有效,值得在临床上推广应用。

Objective To observe the therapeutic effect and safety of intravenous metoprolol on acute myocardial infarction. Methods Eighty patients with confirmed acute myocardial infarction were divided randomly into treatment group and control group. All enrolled patients in both groups were administered routinely recombinate tissue -type plasminogen activator（r- tPA） for intravenous thrombolysis, nitroglycerin for intravenous drip, low molecular weight heparin （LMWH） for subcutaneous injection and oral aspirin. The patients in treatment group were injected metoprolol intravenously at dose of 15mg, 5mg every 5min for three times. Oral metoprolol was administered 15min after intravenous injection, 50mg every 6h for 3 months. The patients in control group were administered oral metoprolol at dose of 6.25mg every 12h for the first week, 12.5mg every 12h for the second week and 25mg every 12h for the third week and maintained that dose for 3 months. The therapeutic effect on both groups was analysed. Results Compared with control group, the fatality rate and incidence rate of rapid arrhythmia were decreased markedly （P 〈 0.01 ）. There was no significant difference in the incidence rate of atrio - ventricular block （ A - VB） between both groups （ P 〉 0.05 ）. Conclusions It is effective and safe that administering intravenous full dose metoprolol as early as possible to patients with acute myocardial infarction. It is worth generalizing the treatment into clinic.