美托洛尔联合二丁酰环磷腺苷钙治疗冠心病心力衰竭并心律失常临床研究

Clinical Study of Metoprolol Combined with Calcium Dibutyryladenosine Cyclophosphate in the Treatment of Patients with Coronary Heart Disease and Heart Failure Complicated with Arrhythmia

目的探讨美托洛尔联合二丁酰环磷腺苷钙治疗冠状动脉粥样硬化性心脏病(简称冠心病)心力衰竭并心律失常的临床疗效。方法选取海南省东方市人民医院心血管内科2019年5月至2022年2月收治的冠心病心力衰竭并心律失常患者117例,按用药方案的不同分为单药组(67例)和联合组(50例)。两组患者均予基础治疗及注射用二丁酰环磷腺苷钙静脉滴注,联合组患者加服琥珀酸美托洛尔缓释片。两组均治疗14 d。结果治疗后,两组患者左室射血分数(LVEF)均较治疗前明显升高,且联合组升高更明显(P<0.05);两组患者左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)均较治疗前明显减小,且联合组减小更明显(P<0.05);两组患者N末端B型脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、半乳糖凝集素-3(Gal-3)水平均显著下降,且联合组下降更明显(P<0.05);联合组患者的24 h房性、室性早搏次数均明显少于单药组,但5 min窦性心律波动R-R间期标准差(SDNN)和5 min窦性心律波动R-R间期平均值标准差(SDANN)均明显大于单药组(P<0.05);两组患者6 min步行距离(6MWT)均明显增大,且联合组明显大于单药组(P<0.05);两组患者明尼苏达心力衰竭生活质量量表(MLHFQ)评分均明显降低,且联合组下降更明显(P<0.05)。结论美托洛尔联合二丁酰环磷腺苷钙治疗冠心病心力衰竭并心律失常,可显著降低患者的血清Gal-3,CK-MB,NT-proBNP水平,改善心功能和心律失常,减轻心力衰竭程度,提升患者的运动能力和生活质量。

Objective To investigate the clinical efficacy of metoprolol combined with calcium dibutyryladenosine cyclophosphate in the treatment of patients with coronary heart disease(CHD)and heart failure complicated with arrhythmia.Methods A total of 117 patients with CHD and heart failure complicated with arrhythmia admitted to the Department of Cardiovascular Medicine in the Dongfang People's Hospital in Hainan Province from May 2019 to February 2022 were selected and divided into the single-drug group(67 cases)and the combination group(50 cases)according to different treatment regimens.The patients in the two groups were given basic treatment intravenous drip of Calcium Dibutyryladenosine Cyclophosphate for Injection,on this basis,the patients in the combination group were given Metoprolol Succinate Sustained-Release Tablets.Both groups were treated for 14 d.Results After treatment,the left ventricular ejection fraction(LVEF)in the two groups was significantly higher than that before treatment,and that in the combination group was significantly higher(P<0.05).After treatment,the left ventricular end-diastolic diameter(LVEDd)and left ventricular end-systolic diameter(LVESd)in the two groups were significantly shorter than those before treatment,and those in the combination group were significantly shorter(P<0.05).After treatment,the levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),creatine kinase-MB isoenzyme(CK-MB),high-sensitivity C-reactive protein(hs-CRP)and galectin-3(Gal-3)in the two groups were significantly lower than those before treatment,and those in the combination group were significantly lower(P<0.05).After treatment,the times of 24-hour atrial premature contraction and ventricular premature contraction in the combination group were less than those in the single-drug group,while the standard deviation of NN intervals(SDNN)in 5 min and the standard deviation of the average NN intervals(SDANN)in 5 min in the combination group were significantly greater than those in the single-drug group(P<0.05).After treatment,the 6-minute walk test(6MWT)in the two groups was significantly longer,and that in the combination group was significantly longer than that in the single-drug group(P<0.05).After treatment,the score of Minnesota Living with Heart Failure Questionnaire(MLHFQ)in the two groups was significantly lower,and that in the combination group was significantly lower(P<0.05).Conclusion Metoprolol combined with calcium dibutyryladenosine cyclophosphate is effective in the treatment of patients with CHD and heart failure complicated with arrhythmia,which can decrease significantly the levels of serum Gal-3,CK-MB,NT-proBNP of patients,improve cardiac function and arrhythmia,alleviate the degree of heart failure,and improve their exercise ability and quality of life.