不同心律的慢性充血性心力衰竭患者对美托洛尔的耐受性比较

A comparison of tolerance of metoprolol in chronic congestive heart failure patients with different cardiac rhythm

目的 :比较不同心律状态下的慢性充血性心力衰竭 (CHF)患者对美托洛尔治疗的剂量耐受情况。方法 :对 14 6例CHF患者 [其中窦性心律 (窦律 ) 10 3例、心房颤动 (房颤 )心律 2 8例、起搏器心律 15例 ]在常规心力衰竭 (心衰 )治疗基础上口服美托洛尔 ,逐渐加量至目标剂量。治疗目标分别为 :①心室率下降到 5 0～ 6 5次 /min(不低于 5 0次 /min) ;②稍加剂量心功能下降 1级 ;③收缩压不低于 90mmHg(1mmHg =0 .133kPa) ;④达最大剂量 :2 0 0mg/d。结果 :窦律者美托洛尔平均剂量低于房颤和起搏器心律者 [(72 .7± 36 .1)mg/d∶(10 4 .7±2 8.7)mg/d和 (10 8.7± 2 4 .6 )mg/d ,P <0 .0 1];窦律者达心率目标的平均剂量低于达心衰的目标剂量 ,房颤者心率和心衰的目标剂量相当 ,而 3种不同心律患者达心衰目标剂量无明显差异 (P >0 .0 5 )。结论 :不同心律的CHF患者对美托洛尔的耐受性均较好 。

Objective:To compare the tolerance of Metoprolol in congestive heart failure (CHF) patients with different cardiac rhythm.Methods:Metorolol was orally administealed in CHF patients [103 with sinus rhythm, 28 with atrial fibrillation (AF) rhythm and 15 with cardiac pacing rhythm] at the basis of regular regimen and the dosage was increasingly added to the target dose. The target doses were respectively defined as: ① heart rate to 50～65 bpm (no less than 50bpm); ② cardiac function worsen to next degree with dosage adding; ③ systolic blood pressure no less than 90mmHg; ④ to the defined dose of (200 mg/day). Results:The average dose of Metoprolol was lower in patients with sinus rhythm than in patients with AF rhythm and cardiac pacing rhythm ( 72.7 ± 36.1 ) mg/d vs ( 104.7 ± 28.7 ) mg/d and ( 108.7 ± 24.6 ) mg/d, P< 0.01 ). The average dose to heart rate target was less than to heart failure target in patients with sinus rhythm and was almost the same in patients with AF rhythm. There was no significant difference in average doss to heart failure target among all patients with different rhythm. Conclusion:The good tolerance to Metoprolol was found in CHF patients with different cardiac rhythm and was better in patients with AF and cardiac pacing rhythm than with sinus one.