艾司洛尔联合美托洛尔缓释片对急性ST段抬高心肌梗死疗效观察

Efficacy of esmolol combined with metoprolol sustained-release tablets on acute ST elevation myocardial infarction

目的分析艾司洛尔联合美托洛尔缓释片对急性ST段抬高心肌梗死疗效。方法按照ACC/AHA制定的有关急性心肌梗死的诊断标准,选取本院心血管内科2016年7月~2017年3月收治的80例确诊为急性ST段抬高心肌梗死患者,患者随机分为早期静脉注射艾司洛尔联合口服β受体阻滞剂(治疗组)和单纯口服β受体阻滞剂治疗(对照组)。治疗组在入选后立即予静脉注射艾司洛尔[0.25~0.5 mg/kg,然后从0.05 mg/(kg·min)开始,逐渐递增至0.2 mg/(kg·min),维持24 h],在治疗期间如果患者收缩压≤90 mm Hg,心率≤55次/分,心功能严重障碍患者,将立即停药给予相应的治疗。停止服药前半小时应当每天口服47.5 mg的美托洛尔缓释片,1次/d。对照组单纯服用美托洛尔缓释片进行治疗,每天服用2次,25 mg/次。治疗组和对照组均进行急诊PCI治疗及常规冠心病二级预防用药。比较两组急性ST段抬高心肌梗死疗效;3个月后心力衰竭、低血压等并发症发生率;治疗前和治疗3个月后患者BNP、C反应蛋白。结果治疗组急性ST段抬高心肌梗死疗效高于对照组,差异具有统计学意义(P<0.05);治疗组3个月后心力衰竭、低血压等并发症发生率低于对照组,差异具有统计学意义(P<0.05);治疗前两组BNP、C反应蛋白水平比较差异无统计学意义;3个月后治疗组BNP、C反应蛋白优于对照组,差异具有统计学意义(P<0.05)。结论艾司洛尔联合美托洛尔缓释片对急性ST段抬高心肌梗死疗效确切,可有效提高新功能水平,降低BNP指标与心脏不良事件发生率,强化预后效果,值得推广应用。

Objective To analyze the efficacy of esmolol combined with metoprolol sustained-release tablets in patients with acute ST elevation myocardial infarction.Methods According to the diagnostic criteria of acute myocardial infarction established by ACC/AHA,80 patients diagnosed as acute ST-segment elevation myocardial infarction admitted from July 2016 to March 2017 in our hospital were randomly divided into early stage Intravenous esmolol combined with oral beta-blockers(treatment group)and simple oral beta-blocker treatment(control group).The treatment group was given esmolol i.v.0.25-0.5 mg/kg,then 0.05 mg/(kg·min),increasing gradually to 0.2 mg/(kg·min)for 24 hours immediately after enrollment.Patients with systolic blood pressure≤90 mmHg,heart rate≤55 beats/min,severe cardiac dysfunction in patients with immediate withdrawal will be given the appropriate treatment.Half an hour before stopping taking orally daily oral metoprolol 47.5 mg tablets,1 time/d.The control group was treated with metoprolol sustained-release tablets,taking 2 times a day and once with 25 mg.The treatment group and the control group were treated with emergency PCI and secondary prevention of coronary heart disease.The efficacy of acute ST-segment elevation myocardial infarction was compared between the two groups.The incidence of complications such as heart failure and hypotension was observed after 3 months.BNP and C-reactive protein were measured before treatment and 3 months after treatment.Results The therapeutic effect of ST-segment elevation myocardial infarction in treatment group was higher than that in control group(P<0.05).The incidence of complications such as heart failure and hypotension was lower in treatment group than in control group after 3 months(P<0.05).There was no significant difference in BNP and C-reactive protein level between the two groups before treatment.After 3 months,BNP and C-reactive protein in the treatment group were better than those in the control group(P<0.05).Conclusion Esmolol combined with metoprolol sustained-release tablets is effective in treating patients with acute ST-segment elevation myocardial infarction,which can effectively improve the level of new functions,reduce the incidence of BNP and adverse cardiac events,and enhance the prognosis.It is worth popularizing and applying.