急性心肌梗塞介入治疗患者早期应用β受体阻滞剂对心功能和自主神经功能状态的影响

Effect of β-blocker early application on cardiac and autonomic nervous functions of the acute myocardial infarction patients with interventional treatment

目的探讨急性心肌梗塞(AMI)介入治疗患者早期应用β受体阻滞剂对心功能和自主神经功能状态的影响。方法将经介入治疗的122例AMI患者,根据有无早期使用β受体阻滞剂分为对照组(62例)和β阻滞剂治疗组(60例),比较两组患者的心功能指标、自主神经功能指标和预后情况。结果首先,相对于对照组,β受体阻滞剂治疗组患者的不良事件发生率和病死率均有所降低,但差异均无统计学意义(33.3%vs.37.1%、6.7%vs.8.1%;χ2=0.189、0.087,P均>0.05)。治疗28 d时,β阻滞剂治疗组患者的左心室射血分数(LVEF)和窦性心搏R-R间期标准差(SDNN)明显高于对照组,而低频段(LF)/高频段(HF)显著低于对照组,差异均有统计学意义[(53±7)%vs.(49±7)%、(186±49)ms vs.(156±53)ms、(1.2±0.5)vs.(2.1±1.0);t=3.440、3.103、5.769,P均<0.05]。结论对于AMI介入治疗患者早期应用β受体阻滞剂(美托洛尔),并根据血浆B型尿钠肽(BNP)水平和病情变化适当调整剂量,能更为有效地促进患者心功能恢复,并促使交感神经活性/迷走神经活性的比值趋于正常水平,可能有助于改善患者的预后。

Objective To investigate the effect of early application of β-blocker on cardiac and autonomic nervous functions of the acute myocardial infarction （AMI） patients with interventional treatment. Methods According to the β-blocker （metoprolol） usage, 122 AMI patients with interventional treatment were divided into the control group （62 cases） and Z-blocker treatment group （60 cases）. Results Compared with the control group, the adverse event and case fatality rates in the β-blocker treatment group were both lower, but had no significant differences （33.3% vs. 37.1%, 6.7% vs. 8.1%; x2 = 0.189, 0.087, all P 〉 0.05）. After a 28-d treatment, the left ventricular ejection traction （LVEF） and standard diviation of NN intervals （SDNN） in the β- blocker treatment group were much higher than that in the control group, while the low frequency （LF）/high frequency （HF） was much lower than control group [（53 ± 7）% vs. （49 ±7）%, （186±49） ms vs. （156±53） ms, （1.2±0.5） vs. （2.1± 1.0）; t = 3.440, 3.103, 5.769, all P〈 0.05]. Conclusion For the AMI patients with interventional treatment, early application of β- blocker （metoprolol） and adjustment of its usage based on the concentration of plasma B-type natriuretic peptide （BNP） and state of the illness changes could effectively promote the cardiac function recovery of AMI patients, also prompt the sympathetic nervous activity / vagus nerve activity ratio returns to the normal level, thus it may help to improve the prognosis of AMI patients.