美托洛尔和培哚普利对心肌梗死患者自主神经失衡和预后的影响

Effects of metoprolol and perindopril on autonomic nervous imbalance and prognosis in patients with myocardial infarction

目的 观察心肌梗死 (AMI)患者应用美托洛尔、培哚普利后的自主神经失衡的变化及其与预后的关系。方法 选择病情、年龄等相匹配的AMI患者随机分为美托洛尔组 (n =6 6 )、培哚普利组 (n =71)及对照组 (n =6 9)。测定三组患者用药前及用药后 4周及随访期的 2 4h心率变异性(HRV)、左室射血分数 (LVEF)、室性心律失常 (室早 >10 /h) ,对比其随访结果。结果 (1)服药组的HRV观察指标高于对照组 [美托洛尔组 :正常窦性心搏间期的标准差 (SDNN)为 (138 5± 32 6 )ms ,相邻心搏间期 >5 0ms的百分数 (PNN50 )为 9 5± 1 5 3,高频功率 (HF)为 (139 9± 33 4)ms2 ;培哚普利组 :SDNN (117 3± 2 2 9)ms,PNN50 9 2± 1 6 ,HF (140 6± 2 0 5 )ms2 ;对照组 :SDNN(87 4± 2 8 6 )ms,PNN506 0± 3 5 ,HF(10 0 3± 2 1 4)ms2 ,P <0 0 5 ];(2 )随访期间服药组的室性心律失常发生率明显低于对照组 ,美托洛尔组为 35 4% ,培哚普利组为 43 5 % ,对照组为 6 6 1% ,P <0 0 5 ;(3)服药组患者的HRV恢复比对照组较早、较快 ;(4 )服药组的EF值正常率高于对照组 ,美托洛尔组EF为 96 % ,培哚普利组EF为 90 % ,对照组EF为 6 4% ,P <0 0 5 ;(5 )对照组的病死率明显高于服药组 ,分别为美托洛尔组病死率为 10 % ,培哚普利组?

Objective To observe changs in the autonomic nervous system and their relation to prognosis of patients with myocardial infarction(MI) after treatment with metoprolol and perindopril. Methods The patients with MI were randomly divided into 3 groups: the metoprolol group ( n =66), the perindopril group ( n =71) and the control group ( n =69) with matched conditions and age. 24 hour heart rate varibility (HRV),ventricular arrhythmia and left ventricular ejection fraction (EF) were examined before medication, 4 weeks after medication and during follow up. Results (1) HRV parameters of the treatment groups were higher than those of the control group: metoprolol group, SDNN (138.5±32.6)ms, PNN 50 9.5±1.5,HF(139.9±33.4)ms 2 ;perindopril group, SDNN (117.3±22.9)ms, PNN 50 9.2±1.6,HF(140.6±20.5)ms 2 ;control group,SDNN (87.4±28.6)ms, PNN 50 6.0±3.5,HF(100.3±21.4)ms 2 , P <0.05. (2) Ventricular arrhythmia of the treatment group was lower than that of the control group. (3) Recovery of the control group occurred later than that of the treatment group. (4) EF values of the treatment groups were higher than those of the control group: metoprolol group 96%, perindopril group 90%,control group 64%, P <0.05. (5) Mortality in the control group was higher than that of the treatment groups:metoprolol group 10%, perindopril group 22%, control group 36%, P <0.05. Conclusions In this study, metoprolol and perindopril elevated HRV both in acute and recovery MI patients. They also improved imbalance of the autonomic nervous system and depressed cardiac function and decreased the mortality of the patients.