应用艾司洛尔治疗冠心病合并快速心律失常

Esmolol in the treatment of coronary heart disease complicated with tachyarrhythmia

目的探讨艾司洛尔辅助胺碘酮治疗对冠心病合并快速性心律失常患者心电图、心功能的影响。方法选取我院心内科冠心病合并快速性心律失常患者94例,随机分为试验组和对照组,每组47例。对照组给予胺碘酮治疗,试验组给予胺碘酮联合艾司洛尔治疗。比较治疗前及治疗48小时后,两组患者的心功能指标:左室射血分数(LVEF)、心排血量(CO)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD);动态心电图指标:PR间期、QTc间期、室性期前收缩(PVC)、短阵室性心动过速;心肌标志物水平:肌酸激酶同工酶(CK-MB)、神经末端前体B型利钠肽(NT-pro BNP)的变化;记录两组药物不良反应情况(肝功能异常、低血压、窦性心动过缓)。结果两组患者LVEF、CO均较治疗前显著升高,且试验组明显高于同一时期对照组(p<0.05);两组LVESD、LVEDD较治疗前明显减少(p<0.05),且试验组明显低于对照组(p<0.05);两组患者心电图PR间期、QTc间期较治疗前显著延长(p<0.05),且试验组明显长于同一时期对照组(p<0.05);两组PVC、短阵室性心动过速较治疗前明显减少(p<0.05),且试验组明显少于对照组(p<0.05);治疗48小时后,两组患者血清CK-MB、NT-pro BNP水平较治疗前显著降低(p<0.05),但差异比较无统计学意义(p>0.05);试验组药物不良反应总发生率显著低于对照组(p<0.05)。结论艾司洛尔辅助胺碘酮用于冠心病合并快速性心律失常患者具有良好效果,对改善心电图指标及心功能可产生重要作用。

Objective To investigate the effect of esmolol assisted amiodarone on ECG and cardiac function in patients with coronary heart disease complicated with rapid arrhythmia.Methods Nity-four patients with coronary heart disease and tachyarrhythmia were randomly divided into experimental group and control group,47 cases in each group.The control group was treated with amiodarone,and the experimental group was treated with amiodarone and esmolol.The cardiac function indexes of the two groups were compared before and after treatment(LVEF),cardiac output(CO),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDd),dynamic electrocardiogram index[PR interval,QTc interval,ventricular pre systolic(PVC),short array ventricular tachycardia]The changes of myocardial marker levels(CK MB),NT pro BNP in the precursor of nerve terminal were observed;The adverse drug reactions(liver dysfunction,hypotension,sinus heart rate bradycardia)were recorded.Results LVEF and CO in both groups were significantly higher than those before treatment,and the experimental group was significantly higher than that in the control group(p<0.05),The LVESD and LVEDd in the two groups were significantly lower than that before treatment(p<0.05),and the experimental group was significantly lower than that of the control group(p<0.05),The PR interval and QTc interval of ECG in the two groups were significantly longer than that before treatment(p<0.05),and the experimental group was significantly longer than that of the control group(p<0.05).The results showed that the PVC and short array ventricular tachycardia in the two groups were significantly lower than that before treatment(p<0.05),and the experimental group was significantly lower than that of the control group(p<0.05).After 48 hours of treatment,the serum CK MB and NT pro BNP levels of the two groups were significantly lower than before treatment(p<0.05),but the difference was not statistically significant(p>0.05);The total incidence of adverse drug reactions in the experimental group was significantly lower than that of the control group(p<0.05).Conclusions Esmolol assisted amiodarone has good effect in the patients with coronary heart disease and tachyarrhythmia,which can improve the ECG index and cardiac function.