早期心率控制对急性心肌梗死患者近期预后的影响

Effect of early heart rate control on the recent prognosis in patients with acute myocardial infarction

目的探讨早期心率控制对急性心肌梗死（AMI）患者近期预后的影响。方法选择本院2011年8月～2013年7月收治的256例起病24 h内入院的AMI患者。所有患者均常规每日应用比索洛尔片,不需调整剂量就达目标心率（55～65次/min）者为A组,未达目标心率者再随机分组于入院后第1天（B组）、第3天（C组）、第7天（D组）,调整比索洛尔用量至目标心率。观察其住院期间及1个月内梗死后心绞痛、再发心肌梗死、恶性心律失常和心原性休克的发生情况。结果 A组、B组和C组患者的心梗后心绞痛、再发心肌梗死、恶性心律失常和心原性休克的发生率均显著低于D组（P〈0.05）。结论起病24 h内入院的AMI患者入院后心率早期（3 d内）控制达标（55～65次/min）可明显改善患者的近期预后,对临床工作具有十分重要的指导意义。

Objective To explore the effect of early heart rate control on the recent prognosis in patients with acute myocardial infarction. Methods 256 patients in our hospital from August 2011 to July 2013 were admitted with acute myocardial infarction within 24 hours of onset. All patients underwent routine daily application of bisoprolol tablets, did not need to adjust the dose of target heart rate（55～65 bpm） for the A group, did not reach the target heart rate were randomly grouped in first days after admission（group B）, third days（group C）, seventh days（group D）, adjust the dosage of bisoprolol to reach the target heart rate. To observe the incidence of postinfarction angina, recurrent myocardial infarction, malignant arrhythmias and cardiogenic shock in hospitalization and within one month. Results the incidence of postinfarction angina, recurrent myocardial infarction, malignant arrhythmias and cardiogenic shock in group A, group B and group C were significantly lower than group D（P0.05）. Conclusion The target heart rate（55～65 bpm） within three days for the AMI patients admitted within 24 hours of onset could significantly improve the recent prognosis of patients, had a very important guiding significance for our clinical work.