美托洛尔对急性心肌梗死后心律失常的疗效观察

Antiarrhythmic effect of metoprolol after acute myocardial infarction

目的观察早期静脉注射后口服美托洛尔对急性心肌梗死(AMI)后心律失常事件的影响,并评估其安全性。方法设安慰剂对照的随机双盲临床试验,治疗组27例,首先静脉注射美托洛尔5 mg,共3次,然后给予口服美托洛尔200 mg/d;安慰剂组26例,除接受AMI的常规治疗,相应安慰剂静脉及口服方法与治疗药相同,入组后24小时及出院前分别记录24小时动态心电图。结果AMI后24小时内美托洛尔组室上性心动过速的例数明显低于对照组(11/27 vs 18/26,P<0.05),心房纤颤的发生美托洛尔组虽有减少趋势,但差异无统计学意义(0/27 vs 2/26,P>0.05);美托洛尔组成对或二联律的室性期前收缩和室性心动过速的例数明显低于安慰剂组(11/27 vs 19/26,5/27 vs 12/26,均P<0.05),心室纤颤两组各发生1例;出院前美托洛尔组的房性期前收缩和室上性心动过速的发生例数明显少于安慰剂组(15/25 vs 21/24,3/25 vs 9/24,P<0.05);成对或二联律的室性期前收缩以及室性心动过速的例数两组差异无统计学意义(2/25 vs 4/24,0/25 vs 2/24,均P>0.05)。结论AMI后早期静脉及口服美托洛尔可有效的抑制心肌梗死后发生的房性和室性心律失常,但应在血流动力学稳定后开始使用,以避免增加心源性休克的风险。

Objective To observe the effect of early intravenous then oral metoprolol in patients with arhythmia after acute myocardial infarction,and to evaluate the safety. Methods Randomised placebo-controlled double-blind trial was desitgned. The treatment group consisted of 27 cases, on the basis of the routine treatment of AMI, adopted metoprolol 5 mg three times by intravenous injection,then oral metoprolol 200 mg a day. One placebo-controlled group consisted of 26 cases, beside accepted conventional therapy of AMI, simultaneously intravenous then oral placebo. The method was same as treatment group. All patients, dynamic electrocardiogram was recorded in prior to discharge and after entering group. Results The supraventricular tachycardia events within 24 hours after acute myocardial infarction were significantly less in treatment group than in placebo-controlled group（11/27 vs 18/26, P〈0.05）. The tendency of developing atrial fibrilation was diminished but there was no statistic sinifiance（0/27 vs 2/26, P〉0.05）;The cases of development of bigem or bigeminal rhythm and ventricular tachycardia were obviously lower in treatment group than in placebo-controlled group（11/27 vs 19/26,5/27 vs 12/26, all P 〈0.05）. One case developed ventricular fibrillation in each group. Before discharge,the cases of development of atrial premature beats and supraventricular tachycardia were obviously lower in treatment group than in placebo-controlled group（15/25 vs 21/24,3/25 vs 9/24, P〈0.05）. But the cases who developed bigem or bigeminal rhythm and ventricular tachycardia had not obviously difference between two groups（2/25 vs 4/24,0/25 vs 2/24,all P 〉0.05）. Conclusion Early intravenous then oral meotoprolol has a powerful antiarrhythmic effect after AMI. But the patients should take meotoprolol when their haemodynamics are stabilized to avoid risk of cardiac shock increasing.