美托洛尔治疗慢性心力衰竭目标剂量探讨

The objective dose of metoprolol in patients with chronic heart failure

目的 探讨美托洛尔在慢性充血性心力衰竭 (心衰 )治疗中的剂量及耐受性。方法 对10 3例心力衰竭伴窦性心律患者在常规心衰治疗基础上加用美托洛尔 ,逐渐加量至目标剂量 ,目标分别为 :①心率下降到 5 0～ 6 5次 /min(不低于 5 0次 /min) ;②稍加剂量心功能下降Ⅰ级 ;③收缩压不低于90mmHg(1mmHg =0 133kPa)。结果 美托洛尔平均维持量为 (72 7± 36 1)mg/d(12 5～ 175mg/d)。其中 6 8例 (6 6 0 % )达心率目标 ,35例 (34 0 % )达心衰目标 ,无一例达血压目标。随访患者多因认识不足或不适当治疗而减量或停用美托洛尔。结论 在治疗期间内 ,心力衰竭 (NYHAⅡ级～Ⅳ级 )患者对合适剂量的美托洛尔耐受性较好。

Objective To evaluate the target dose of metoprolol in patients with chronic heart failure (CHF) Methods On the basis of regular treatment, metoprolol was used in 103 patients with CHF and sinus rhythm, the dose was increased gradually to objective one The objective doses were:①The heart rate decrease to 50～65bpm(no less than 50bpm); ②the cardiac function decrease I degree of NYHA class after a little additional dose; ③systolic blood pressure nearly to 90mm Hg(no less than 90mm Hg) Results The average dose of metoprolol was 72 7mg/d±36 1mg/d(12 5mg/～175mg/d) Of all patients, 68(66 0%) reached objective heart rate, 35(34 0%) reached objective degree of heart failure and no one's blood pressure reached the objective value Some patients stopped or reduced the dose of metoprolol due to ignorance of the therapeutic regimen or due to other reasons Conclusion A good tolerance and safety for metoprolol were found in patients with CHF