静脉注射美托洛尔对快室率房颤伴心衰的疗效观察

Observation of Effectiveness and safety of Intravenous Metoprolol on Atrial Fibrillation of Rapid Ventricular Rates with Heart Failure

目的探讨静脉注射美托洛尔对房颤快速心室率伴心衰的疗效及安全性。方法对房颤快室率伴心衰的患者经常规治疗,观测0.5h,如心率仍>100beat·min-1,血压≥100/60mmHg(1mmHg=0.133kPa)以上的患者,随机分三组,1组为美托洛尔注射液10mg稀释后经微泵静注(微泵组)1h;2组为美托洛尔注射液5mg,10min缓慢静脉推注(推注组),观察10min,如心率仍大于100beat·min-1,血压≥90/60mmHg则再重复给药一次;3组为生理盐水对照组。当心率≤60beat·min-1,血压<90/60mmHg时停止;各组静注药物前及开始给美托洛尔注射液或生理盐水后1h,观察症状、体征、心率、血压、肺部罗音、血流动力学和ANP、BNP等指标。结果静脉注射美托洛尔后大多数患者心衰症状、体征明显改善,心室率、BNP和ANP显著下降且比对照组明显,收缩压、舒张压有所降低但与对照组无显著差异,无创心功能参数中CO,SI,SV,LVET显著增加并且比对照组明显。结论美托洛尔静脉注射治疗快室率房颤伴心衰是有效和安全的。

OBJECTIVE To investigate the effectiveness and safety of intravenous metoprolol on the patients with atrial fibrillation of rapid ventricular rates complicated by heart failure. METHODS Patients with atrial fibrillation of rapid ventricular rates complicated by heart failure, who were treated by heart failure therapy regularly for half an hour, were divided into three groups, whose heart rate was above 100 beats/min and blood pressure was above 100/60 mmHg. The first group was administrated Metoprolol 10mg by minipump in an hour; the second group was administrated metoprolol 5 mg in 10 minutes by injection directly, adding other 5 mg if heart beats was still above 100 beats · min^-1 and blood pressure was above 100/60 mmHg after 10 minutes; the third group was administrated normal saline as the control group. If either ventrieular rate was down to 60 beats · min^-1 or blood pressure was down to 90/ 60 mmHg, experiments would be terminated. Symptom, physical sign, heart rate, blood pressure, parameters of haemodynamics, blood BNP and ANP were observed at 0 hour and 1 hour after injection of metoprolol or normal saline. RESULTS The clinical symptom and physical sign were improved significantly in both intravenous metoprolol treated groups. Compared with control group,the heart rate and BNP of both intravenous metoprolol treated groups were decreased significantly （ P 〈 0. 05 ） , the decrease of blood pressure in both intravenous metoprolol treated groups was not statistically significant compared with control group. In the parameters of haemodynamics, CI, CO, SV, SI, LVET were increased significantly in minipump group compared with the control group（ P 〈 0.05 ） , but the injection group did not have the similar effect. CONCLUSION Intravenous metoprolol is effective and safe for the management of rapid veotricular rates of atrial fibrillation with heart failure.