β受体阻滞剂影响静息心率与我国急性心肌梗死预后的关系

Beta-blockers reduced heart rate level in patients with acute myocardial infarction and their prognosis in China

目的采用Meta分析的方法分析应用B受体阻滞剂降低我国人群静息心率水平对急性心肌梗死（AMI）患者死亡率的影响，为AMI临床急诊治疗的选择提供参考依据。方法全面收集国内发表的有关AMI患者应用β受体阻滞剂降低静息心率与死亡率关系的研究文献，对符合条件的所有研究结果利用RevMan软件进行固定效应模型的Meta分析。计算应用β受体阻滞剂后AMI患者心率慢组相对心率快组发生死亡的危险（RR），评价心率快慢对AMI患者生存的影响，并用漏斗图分析发表性偏倚。结果符合纳入标准的共17篇文献，总样本量2911例。其中心率慢组1561例，死亡77例；心率快组1350例，死亡217例；合并RR=0．30，95％CI是（0．27～0．42）。漏斗图分析提示存在发表性偏倚。结论AMI患者应用β受体阻滞剂控制心率水平与病死率之间存在关联。AMI后心率控制不佳者死亡危险增加，心率可能作为评估AMI患者预后的指标之一。

Objective By using the Meta analysis to determine the influence of β-blockers reduced resting heart rate of Chinese population on the fatality of the patients with acute myocardial infarction （AMI） , in order to provide a reference for the clinical e-mergency treatment of AMI. Methods A comprehensive collection of an epidemiologieal study published domestically on the rela-tionship between β-blockers reduced resting heart rate and the mortality in AMI patients was carried out. Meta analysis was done by using Rev Man software with fixed effect model and random effect model for all the research results. The relative risk （RR） of death of AMI patients in slow heart rate group relative to those in quick heart rate group after application of β-bloekers was calculated. The influence of heart rate level on the survival of AMI patients was evaluated. The publication bias was analyzed by funnel plot. Results A total of 17 articles were up to the mustard, and the total sample size was 2,911 cases. The slow heart rate group included 1,561 cases, including 77 cases of death. The quick heart rate group included 1,350 cases, including 217 cases of death. RR was equal to 0.33, and 95% confidence interval was （0.27 - 0.42）. Funnel plot analysis showed a presence of publication bias. Conclusion There is a correlation between β-blockers controlled heart rate level and fatality in AMI patients. Fatality is increased in poorly controlled group. Heart rate may be a forecasting marker to assess the prognosis of AMI.