美托洛尔并地高辛对房颤伴心力衰竭患者心室率及心功能的影响

Influence of metoprolol plus digoxin on ventricular rate and heart function of patients with atrial fibrillation and heart failure

目的:观察美托洛尔联合地高辛对永久性房颤(AF)伴心力衰竭(CHF)患者心室率及运动耐量的影响。方法:选择我院心血管内科门诊及住院AF合并CHF患者共78例,随机分为两组:地高辛组(A组)39例,地高辛联合美托洛尔组(B组)39例。入选病人常规使用利尿剂、血管紧张素转换酶抑制剂、肠溶阿斯匹林(或华法令)和地高辛治疗,待病人无液体潴留,体重恒定后,B组加美托洛尔,两组病人在药物达到治疗剂量后,再予维持剂量并观察12周。两组均于入选时及治疗第12周末记录心室率,测12导联心电图,24 h动态心电图(Hol-ter),左室射血分数(LVEF)及6 min步行试验(6 MWT),评价心功能。结果:(1)Holter检测显示A组最小、平均心室率和B组最小、平均和最大心室率在治疗后均显著降低(P均<0.01),B组治疗后最大、平均心室率均较A组显著降低(P<0.01);(2)两组病人的LVEF和6MWT治疗后均显著增加(P<0.01),B组治疗后较A组显著增加(P<0.01)。无不能耐受治疗和严重并发症发生。结论:适当剂量的美托洛尔联合地高辛能控制永久性AF伴CHF患者的心室率,显著改善其心室功能,而且安全。

Objective： To study the influence of metoprolol plus digoxin on ventricular rate and heart function of patients with atrial fibrillation and heart failure. Methods： A total of 78 patients with atrial fibrillation and heart failure were averagely divided to digoxin group （group A） and digoxin plus metoprolol group （group B）. The patients of di- goxin group was treated with routine therapy and digoxin. The patients of digoxin plus metoprolol group was treated with metoprolol above the base of digoxin group therapy. Therapeutic course was 12 weeks. The 12--lead electrocardiogram, dynamic ECG （DCG） , left ventricular ejection fraction （LVEF） and 6--minute walk test （6 MWT） were examined before and 12 weeks after therapy. Results： （1） The DCG show that min and average ventricular rate of group A, min, max, and average ventricular rate of group B all significantly decreased （P〈0. 01 all）, but max and average ventricular rate of group B decreased more than those of group A （P〈0. 01）. （2） The LVEF and 6 MWT of two groups significantly increased after therapy （P〈0. 01 all）, but of group B increased more than those of group A. （3） There was no serious complication to happen. Conclusion： The metoprolol plus digoxin may safely and effectively control ventricular rate and improve heart function in patients with atrial fibrillation and heart failure.