普罗帕酮和美托洛尔治疗病毒性心肌炎致期前收缩的比较

Comparision of the Therapeutic Effects of Propafenone and Metoprolol on Extrasystole Induced by Viral Myocarditis

目的比较普罗帕酮和美托洛尔治疗病毒性心肌炎（VM）所致室上性和室性期前收缩的疗效和不良反应。方法将108例VM致频发室上性（11例）或室性（97例）期前收缩且需要抗心律失常药物治疗的患儿随机分为二组,分别予普罗帕酮（56例）5-7mg/（kg·次）,每6h一次,减少或控制后改为每8h一次,症状消失1个月,改为2次/d再持续用药3个月停药,总疗程5～6个月。和美托洛尔（52例）2～3mg/（kg·d）,分2次服用,连续服用2周,无效停药,有效持续用药3个月,总疗程4～6个月,比较二组的起效时间、疗效和不良反应。结果普罗帕酮组的显效率71.34%（40/56例）、总有效率91.07%（51/56例）,均较美托洛尔组高（分别为40.38%、69.23%）（χ^210.572,8.211Pa〈0.005）,但二组的有效率比较无显著性差异（χ^21.249P〉0.05）。普罗帕酮起效时间（8.48±6.02）h较美托洛尔短（96.21±31.24）h（P〈0.05）。但普罗帕酮组不良反应发生率达25.0%、心血管不良反应发生率达14.29%,较美托洛尔组高（分别为5.77%、1.92%）（Pa〈0.05）。结论普罗帕酮与美托洛尔治疗VM所致的期前收缩,疗效均肯定,但前者更有效、起效更快,但均需注意其致心律失常作用,及时调整药物剂量或种类。

Objective To compare the efficacy and side effects of propafenone and metoprolol therapies on ventricular or supraventricular extrasystole induced by viral myocarditis（VM）. Methods One hundred and eight children with ventricular or supraventricular premature beats associated with VM were randomly divided into propafenone or metoprolol therapy protocols, the former included 56 patients and the latter included 52 patients. Total courses of treatment were 4 to 6 months. The therapeutic efficacies, including the general outcome of the treatment reglmens,the therapeutic effect onset time after medication and side effects of the drug of the 2 groups were compared. Results In the propafenone group,bigger ratios of cases＇therapeutic outcome satisfied the criteria of both excellent and effective（71.3% and 91.07% respectively） than metoprolol group （40.38% and 69.23% ,respectively） （Pa 〈0. 005）,while the efficacy rate was not significantly different between both groups（ P 〉 0.05 ）. The average therapeutic effect onset time of the propafenone group was （8.48±6.02 ） h which shorter than that of metoprolol group was （96.21 ±31.24） h （ P 〈 0.05 ）. Nevertheless, the incidence rate of adverse effects in former group, especially cardiovascular side effects （25.0% and 14.29% ,respectively） ,was significantly higher than the latter （5.77% and 1.92% ,respectively） （P 〈 0.05 ）. Conclusions Both propafenone and metoprolol are effective therapeutic options in the treatment of extrasystole induced by VM in children. Propafenone seems generally more effective than metoprolol with shorter therapeutic effect onset time. Precaution on the possible side effects especially their arrhythmogenic effects should always be exercised and withdrawal of the drug or dosage adjustment should be made in time if necessary.