美托洛尔对慢性充血性心力衰竭患者心脏结构及心率震荡的影响

目的观察慢性充血性心力衰竭(CHF)患者心率震荡(HRT)现象的特点,以及美托洛尔治疗后患者心脏结构、功能及HRT的变化。方法测定并比较118例慢性充血性心力衰竭者和40例健康体检者(C组)的左心室舒张末期内径(LVDD)、左心室射血分数(LVEF)、室性早搏后的震荡初始(TO)和震荡斜率(TS)值;并将慢性充血性心力衰竭患者随机分为美托洛尔治疗组(A组)和基础药物治疗组(B组),各39例。A组在B组常规治疗基础上加用美托洛尔口服,所有慢性充血性心力衰竭患者分别于治疗6周后复查24 h动态心电图及心脏彩超。结果 C组TO<0,而CHF患者TO>0;CHF患者的TS显著低于C组(P<0.05)。CHF组患者治疗6周后,LVDD、LVEF、HRT均有显著改善:LVDD、TO下降,LVEF、TS升高,且A组较B组改善显著,差异有统计学意义(P<0.05)。结论慢性充血性心力衰竭患者中会出现HRT钝化现象,美托洛尔能改善其HRT和心脏结构及功能。

Objective To observe the characteristics of the heart rate turbulence （HRT） in patients with congestive heart failure （CHF） and the therapeutic effect of metoprolol on heart structure, function and HRT. Methods 118 Patients with CHF （CHF Group） and 40 persons with premature ventricular beats （Group C） were investigated in this study, left ventricular end diastolic dimension （LVDD）, left ventricular ejection （LVEF）, fraction turbulence onset （TO） and turbulence slope （TS） were analyzed and compared between the two groups. Patients in the CHF group were randomly divided into metoprolol treatment group （Group A） and conventional treatment group （Group B）, metoprolo｜ was added in Group A beside the conventional treatment. All patients with CHF were examined with ambulatory electrocardiogram monitoring for twenty-four hours and Echocardiography after 6 weeks treatment. Results TO〈0 in Group C and〉0 in CHF Group. TS was higher in Group C than that of the CHF Group （P〈0.05）. LVDD and TO decreased and LVEF and TS increased respectively after oral administration of metoprolol for 6 weeks in the CHF group, and there was a significant difference between Group A and Group B （P〈0.05）. Conclusion There is a passivation phenomena of HRT in CHF patients; metoprolol can improve HRT and cardiac function.