扩张型心肌病停用β受体阻滞剂后的临床观察

Clinical reactions to stopping beta-receptor blocker in patients with dilated cardiomyopathy

目的观察扩张型心肌病（DCM）并发充血性心力衰竭（CHF）患者停止美托洛尔治疗后的临床不良反应。方法对69例服用美托洛尔≥18个月、心功能Ⅰ-Ⅱ级、无恶性室性心律失常及快速性心律失常的DCM并发CHF患者随机分为治疗组（停用美托洛尔35例）和对照组（不停用美托洛尔34例）。治疗组递减美托洛尔直到完全停服,随访期6个月。结果治疗组心功能恶化和心律失常发生率均明显高于对照组（P〈0.05或P〈0.01）。治疗组与对照组相比心率、收缩压、舒张压、LVEF明显增加（P均〈0.01）。结论 DCM并发CHF的患者服用β受体阻滞剂后停用会出现猝死、心力衰竭恶化、快速性心律失常等不良临床后果,如无停药指征,DCM并发CHF患者长期甚至终身服用β受体阻滞剂非常必要。

Objective To observe the clinical adverse reactions to stopping beta-receptor blocker in patients with dilated cardiomyopathy（DCM） associated with congestive heart failure（CHF）.Methods 69 patients taking Metoprolol orally for 18 months or over,with NYHA function grades Ⅰ～Ⅱ,with DCM associated with CHF and without malignant ventricular arrhythmias and rapid ventricular arrhythmias were assigned to a treated group（35 cases,stopped beta-receptor blocker） and a control group（34 cases,kept taking beta-receptor blocker）.The treated group reduced Metoprolol progressively untill completely stopping.A 6-month follow-up was performed.Results Compared with the control group,the treated group had higher rates of NYHA function deterioration and cardial arrhythmias（P0.05 or P0.01）.Heart rate,systolic pressure,diastolic pressure and LVEF in the treated group also elevated significantly（all P0.01）.Conclusion Patients with DCM associated with CHF stopping beta-receptor blocker easily induced sudden death,deterioration of heart failure,rapid ventricular arrhythmias,et al.If no stopping drug signs,tt is essential for patients with DCM associated with CHF to take beta-receptor blocker for a long-term even for their lifetime.