CAJ | 학술논문

目的观察琥珀酸美托洛尔缓释片对慢性心房颤动(AF)伴慢性充血性心力衰竭(CHF)患者心室率及心功能的影响.方法慢性AF合并CHF患者共69例,随机分为治疗组(35例)和对照组(34例),两组均常规使用地高辛、利尿剂、血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)、抗凝剂.治疗组在常规治疗的基础上给与琥珀酸美托洛尔缓释片.治疗6个月,观察两组治疗前后静息心室率、运动后心室率、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)及6 min步行试验.观察治疗后6个月时的临床症状变化.结果 ①两组患者的静息心室率治疗后比治疗前均明显降低(P＜0.01);运动后心室率治疗组治疗后比治疗前明显减低(P＜0.01),对照组治疗前后变化不显著(P＞0.05),治疗后运动后心室率治疗组比对照组明显减低(P＜0.01);②治疗6个月后两组左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)、6 min步行试验都有明显改善(P＜0.01～0.05),但治疗组明显优于对照组,差异有统计学意义(P＜0.05);③治疗组临床症状改善,总有效率为93.8%,明显高于对照组的77.4%(P＜0.05).结论在使用强心、利尿、ACEI或ARB基础上,琥珀酸美托洛尔缓释片能有效控制慢性AF伴CHF患者心室率,显著改善心功能,改善心室重塑.
목적 관찰호박산미탁락이완석편대만성심방전동(AF)반만성충혈성심력쇠갈(CHF)환자심실솔급심공능적영향.방법 만성AF합병CHF환자공69례,수궤분위치료조(35례)화대조조(34례),량조균상규사용지고신、이뇨제、혈관긴장소전환매억제제(ACEI)혹혈관긴장소Ⅱ수체길항제(ARB)、항응제.치료조재상규치료적기출상급여호박산미탁락이완석편.치료6개월,관찰량조치료전후정식심실솔、운동후심실솔、좌실서장말기내경(LVEDD)、좌실수축말기내경(LVESD)、좌실사혈분수(LVEF)급6 min보행시험.관찰치료후6개월시적림상증상변화.결과 ①량조환자적정식심실솔치료후비치료전균명현강저(P＜0.01);운동후심실솔치료조치료후비치료전명현감저(P＜0.01),대조조치료전후변화불현저(P＞0.05),치료후운동후심실솔치료조비대조조명현감저(P＜0.01);②치료6개월후량조좌실서장말내경(LVEDD)、좌실수축말내경(LVESD)、좌실사혈분수(LVEF)、6 min보행시험도유명현개선(P＜0.01～0.05),단치료조명현우우대조조,차이유통계학의의(P＜0.05);③치료조림상증상개선,총유효솔위93.8%,명현고우대조조적77.4%(P＜0.05).결론 재사용강심、이뇨、ACEI혹ARB기출상,호박산미탁락이완석편능유효공제만성AF반CHF환자심실솔,현저개선심공능,개선심실중소.
Objective To study the influenc of metoprolol succinate sustained-release tablets therapy on ventricular rate and heart function of patients with chronic atrial fibrillation(CHF)and chronic heart failure(HF).Methods A total of 69 patients with chronic atrial fibrillation and chronic heart failure were randomly divided into treatment group(35 cases)and control group(34 cases).The general therapy included digoxin,diuretics,angiotensin-converting enzyme inhibitors(ACEI)or angiotensin-Ⅱ-receptor antagonists(ARB)and anticoagulants for a 6-momth follow-up period.The patients of treatment group was treated with metoprolol succinate sustained-release tablets above the base of the general therapy.The ventricular rate at rest and the ventricular rate after 6-minute walk,left ventricular end diastolic dimension(LVEDD),left ventricular end systolic dimension(LVESD),left ventricular ejection fraction(LVEF)and the distance of 6-minute walk were examined before and 6 months after therapy.After 6 months,to compare the changes of clinical manifestations.Results ①The ventricular rate at rest decreased significantly in both two groups(P＜0.01),the ventricular rate after 6-minute walk decreased significantly in treatment group 6 month after treatment(P＜0.01),but there was no significant difference betwen before and after treatment in control group on the ventricular rate after 6-minute walk(P＞0.05),and the ventricular rate after 6-minute walk was decreased more in tretment group than that in control group(P＜0.01).②The LVEF,LVEDD,LVESD and the distance of 6-minute walk in both groups had significant improvement as compared with before treatment(P＜0.01～0.05),with the treatment group showing a better improvement than in control group(P＜0.05).③The total responsive rate in the treatment group(93.8%)was significantly higher than in control group(77.4%)(P＜0.05).Conclusion Based on the medication of digitalis,diuretics and ACEI or ARB,metoprolol succinate sustained-release tablets therapy can effectively control ventricular rate,significantly improve heart function and also reverse left ventricular in patients with chronic atrial fibrillation and chronic heart failure.