静脉注射倍他乐克在急性心肌梗死早期应用的临床观察

Effect on the early application of intravenous metoprolol to patients with acute myocardial infarction.

目的：观察静脉注射倍他乐克治疗急性心肌梗死（AMI）早期的临床疗效。方法：87例AMI患者随机分为对照组40例、治疗组47例；对照组常规给予rt-pA、低分子肝素钙、阿司匹林、ACEI、硝酸甘油等药物；治疗组在常规治疗的基础上，静脉注射倍他乐克5mg（1mg／min），共3次，每次间隔5rain，静脉注射完成后，根据病情口服倍他乐克25～50mg，q12h。观察两组治疗前后心率、血压变化，ST段回复时间，室性心律失常，心衰，死亡，房宣传导阻滞等不良反应。结果：静脉应用倍他乐克后，患者心率明显下降，由（102．2±11.5）次／分降至（86．8±11．1）次／分（P〈0．05）；早期静脉应用倍他乐克可以有效预防、治疗心律失常．与对照组相比，差异有统计学意义（P〈0．05）；在缓解心绞痛、保护心功能、心肌酶峰值及峰值出现时阎、住院后再梗死、梗死后心绞痛、死亡等心脏终点事件明显优于对照组（P〈0．05）；低血压、心动过缓等发生率相比较差异无显著意义（P〉0．05）。结论：早期静脉应用倍他乐克安全、有效．可明显改善预后。

Objective：To access the clinical effect of early intravenous naetoprolol therapy in patients with acute myocardial infarction （AMI）. Methods：87 patients after AMI were randomly divided into study group and control group. The control group was treated with combined therapy of rt-pA, LMWA, aspirin, ACEI, Nitroglycerin. The study group received 5mg naetoprolo i. v. on the base of normal treatment, all together three times in every 5 minutes with the total of 15 nag, then the study group began oral application of naetoprolo 25 - 50 nag, q12h. The heart rates, blood pressure, the persistent time of ST-segnaent elevating, heart failure syndrome, malignant ventricular arrhythnaia and sudden death was observed. Results： The heart rate decreased obviously after intravenous naetoprolol was injected, from （ 102. 2 ± 11.5 ） bpna to（86.8±11.1 ） bpna（ P〈 0.05） ; Intravenous metoprolol can treat and prevent arrhythnaias effectively（ P〈 0. 05）; It can decrease the incidence of malignant ventricular arrhythmia and sudden death（P〈 0. 05）. Conclusions： Intravenous naetoprolol is safe and efficacious in the treatment of the patients with acute myocardial infarction.