胺碘酮联合美托洛尔治疗急性心肌梗死并发心律失常疗效及对血清炎症因子氧化应激和血管内皮功能的影响

Curative Effect of Amiodarone Combined with Metoprolol in the Treatment of Acute Myocardial Infarction Complicated with Arrhythmia and Its Influence on Serum Inflammatory Factors Oxidative Stress and Vascular Endothelial Function

目的:探讨胺碘酮联合美托洛尔治疗急性心肌梗死并发心律失常的临床疗效及其对血清炎症因子、氧化应激和血管内皮功能的影响。方法:选取2017年9月至2020年10月本院收治的116例急性心肌梗死并发心律失常患者,简单随机分为三组,胺碘酮组(n=38)、美托洛尔组(n=38)、联合组(胺碘酮联合美托洛尔,n=40),比较各组血清炎症因子、氧化应激水平、血管内皮功能及不良反应。结果:联合组临床治疗总有效率92.50%高于胺碘酮组的78.95%、美托洛尔组的76.32%(P<0.05);治疗后三组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、内皮素(ET-1)、血管性假血友病因子(vWF)、丙二醛(MDA)水平比治疗前均明显下降,血清一氧化氮(NO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPX)水平均明显上升,且联合组上述指标下降或上升幅度均明显大于其他两组,差异均有统计学意义(P<0.05);联合组不良反应发生率12.50%,胺碘酮组不良反应发生率15.79%,美托洛尔组18.42%,差异无统计学意义(P>0.05)。结论:胺碘酮联合美托洛尔治疗急性心肌梗死并发心律失常临床疗效更显著,可有效降低患者血清炎症因子水平,改善其氧化应激反应及血管内皮功能,安全性好,值得推广。

Objective:To investigate the clinical effects of amiodarone combined with metoprolol in the treatment of acute myocardial infarction complicated with arrhythmia,and its influence on serum inflammatory factors,oxidative stress and vascular endothelial function.Methods:Totally 116 patients with acute myocardial infarction complicated with arrhythmia who were admitted to the hospital between September 2017 and October 2020 were randomly divided into amiodarone group(n=38),metoprolol group(n=38),and combination group(amiodarone combined with metoprolol,n=40).Serum inflammatory factors,oxidative stress,vascular endothelial function and adverse reactions were compared between the groups.Results:The total clinical response rate in the combination group(92.50%)was higher than that in the amiodarone group(78.95%)or the metoprolol group(76.32%)(P<0.05).After treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),endothelin-1(ET-1),von Willebrand factor(vWF),and malondialdehyde(MDA)were significantly decreased,while the levels of serum nitric oxide(NO),superoxide dismutase(SOD),and glutathione peroxidase(GPX)were significantly increased in the three groups.The decreases or increases of the combination group were significantly greater than those of the other two groups(P<0.05).The incidence of adverse reactions was 12.50%in the study group,15.79%in the amiodarone group,and 18.42%in the metoprolol group(P>0.05).Conclusion:Amiodarone combined with metoprolol is markedly effective in the treatment of acute myocardial infarction complicated with arrhythmia.It can effectively reduce the levels of serum inflammatory factors,and improve oxidative stress response and vascular endothelial function in the patients,with good safety.