美托洛尔对经皮冠状动脉介入术后冠心病患者心肺功能恢复影响

Effect of metololol on cardiopulmonary function recovery in patients with coronary heart disease after percutaneous coronary intervention

目的探讨美托洛尔对经皮冠状动脉介入术(PCI)后冠心病患者心肺功能恢复的影响。方法选取自2020年11月至2021年9月于北部战区总医院心血管内科确诊冠心病并行PCI且在出院前完成心肺功能运动试验(CPET)的401例患者为研究对象。根据住院期间是否服用美托洛尔,将患者分入美托洛尔组(n=141)和非美托洛尔组(n=260)。非美托洛尔组患者住院期间的药物治疗为基础药物治疗;美托洛尔组患者住院期间的药物治疗是在基础药物治疗上加用琥珀酸美托洛尔缓释片。查阅医院计算机记录和随访记录,获得每例入选患者的医疗信息。基线包括人口学特点、影像学结果、临床诊断、实验室检查结果、用药史、烟酒史、病史,以及CPET结果等。在患者出院后第1、6、12个月进行随访,观察术后不良事件发生情况。采用倾向性评分匹配分析法对变量进行调整,按1∶1匹配。结果匹配前,与非美托洛尔组比较,美托洛尔组入院心率更高,血清肌酐水平更低,既往患有高血压和糖尿病的比例更高,入院后服用钙通道阻滞剂、硝酸盐、血管紧张素受体拮抗剂的比例更高,差异有统计学意义(P<0.05);匹配后,两组患者基线资料比较,差异均无统计学意义(P>0.05)。匹配前,与非美托洛尔组比较,美托洛尔组脚踏车试验阳性患者比例更低,差异有统计学意义(P<0.05);匹配后,与非美托洛尔组比较,美托洛尔组无氧阈(AT)状态下代谢当量和AT状态下摄氧量更高,脚踏车试验阳性患者比例更低,差异有统计学意义(P<0.05)。匹配前后,两组患者术后不良事件发生率比较,差异均无统计学意义(P>0.05)。结论美托洛尔对PCI后冠心病患者的心肺功能恢复具有改善作用。

Objective To investigate the effect of metoprolol on cardiopulmonary function recovery in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 401 patients who were diagnosed with coronary heart disease and underwent PCI in the Department of Cardiology of General Hospital of Northern Theater Command from November 2020 to September 2021 and completed cardiopulmonary exercise testing(CPET)before discharge were selected as subjects.Patients were assigned to metoprolol group(n=141)and non-metoprolol group(n=260)based on whether they had taken metoprolol during hospitalization.Nonmetoprolol group of patients during hospitalization as the basis of drug therapy,metoprolol group was treated with metoprolol sustainedrelease tablets in addition to basic medication during hospitalization.Hospital computer records and follow-up records were consulted to obtain the medical information of each enrolled patient.The baseline included demographic characteristics,imaging findings,clinical diagnosis,laboratory results,medication history,tobacco and alcohol history,medical history,and CPET results.Patients were followed up at 1,6 and 12 months after discharge to observe the incidence of postoperative adverse events.The variables were adjusted by the propensity score matching analysis method and matched at 1:1.Results Before matching,compared with the non-metoprolol group,the metoprolol group had higher admission heart rate,lower serum creatinine level,higher rates of pre-existing hypertension and diabetes,and higher rates of calcium channel blockers,nitrates and angiotensin receptor antagonists after admission,with statistically significant differences(P<0.05).After matching,there was no significant difference in baseline data between the two groups(P>0.05).Before matching,compared with non-metoprolol group,the proportion of bicycle test positive patients in metoprolol group was lower,and the difference was statistically significant(P<0.05).After matching,compared with non-metoprolol group,metoprolol group had higher metabolic equivalent and oxygen uptake in anaerobic threshold state,and lower proportion of patients with positive bicycle test,with statistical significance(P<0.05).Before and after matching,there was no significant difference in the incidence of postoperative adverse events between 2 groups(P>0.05).Conclusion Metoprolol can improve cardiopulmonary function in patients with coronary heart disease after PCI.