艾司洛尔治疗急性心肌梗死后交感风暴的临床观察

Clinical observation of esmolol for the treatment of acute myocardial infarction with sympathetic storm

目的 探讨艾司洛尔治疗急性心肌梗死后交感风暴的效果及安全性.方法 选择60例在我院住院期间发生交感电风暴的急性心肌梗死患者60例.随机分为两组,艾司洛尔组:电复律或电除颤+艾司洛尔组30例;对照组:电复律或电除颤+胺碘酮组30例.结果 艾司洛尔组有效率为93.33％(28/30),胺碘酮组有效率70.00％ (21/30),差异有统计学意义(x2=5.455,P=0.020).静脉使用艾司洛尔治疗组成功终止交感风暴的比率要显著高于胺碘酮治疗组(28％与21％),两组比较差异有统计学意义(P=0.020).艾司洛尔组室性心动过速或心室颤动复发次数明显减少,相应除颤次数较对照组少[(3.30±2.76)次与(6.83±4.58)次,P=0.001],未发生不能维持的低血压状态和严重缓慢性心律失常,观察两组NT-proBNP水平差异无统计学意义(P＞0.05).结论 静脉使用艾司洛尔治疗急性心肌梗死后交感风暴是安全有效的,值得在临床治疗中推广应用.

Objective To explore the efficacy and safety of esmolol for the treatment of acute myocardial infarction patients with sympathetic storm.Methods Sixty acute myocardial infarction patients who suffered from sympathetic storm during the hospitalization from January 2013 to January 2015 in the People's Hospital of Baoji City.The patients were randomly divided into two groups : esmolol group(patients were treated with cardioversion or electric defibrillation and esmolol, n =30) and control group (patients were treated with cardioversion or electric defibrillation and amiodarone, n =30).Results The effective rate of esmolol group was 93.33％ (28/30), of control group was 70.00％ (21/30), and the difference was significant (x2 =5.455, P =0.020).The success rate of esmolol group which terminated sympathetic storm was significantly higher than control group (28％ vs.20％, P =0.020).Recurrence of ventricular tachycardia or ventricular fibrillation after esmolol treatment was significantly lower, the corresponding were less (3.30± 2.76 vs.6.83 ± 4.58, P =0.001).Esmolol group was no occurrence of hypotension that could not be corrected or severe slow arrhythmia.NTproBNP level between the two groups was not statistically significant observation (P ＞ 0.05).Conclusion Esmolol treatment of sympathetic storm is better efficacy, safety and be worthy of clinical application.