CAJ | 학술논문

目的：观察常规加量法及快速滴定法加量美托洛尔治疗急性心肌梗死（AMI）的疗效。方法：将发病24h 内诊断为 AMI 且无美托洛尔禁忌证的住院患者60例随机分成两组，在常规治疗的基础上采用不同方法给予美托洛尔，常规加量组采用7d 加量法，快速滴定组采用3d 加量法，两组均在达目标剂量190mg/d 后，以此量维持之，观察两组的疗效。结果：①在随访期间，两组均无患者再发心肌梗死、心衰而再次住院治疗，没有出现猝死等现象；②3月后门诊行心脏超声检查，与常规加量组比较，快速滴定组左室舒张末内径[LVEDd，（55.00±7.56） mm 比（50.00±5.81） mm]显著降低（P ＜0.01），左室射血分数[LVEF，（49.13±10.18）％比（57.84±10.34）％]显著升高（P ＜0.01）。结论：快速滴定法可以更早达到患者美托洛尔的目标量，更早抑制肾素释放，阻断肾素-血管紧张素系统，改善心肌重构和心功能。
목적：관찰상규가량법급쾌속적정법가량미탁락이치료급성심기경사（AMI）적료효。방법：장발병24h 내진단위 AMI 차무미탁락이금기증적주원환자60례수궤분성량조，재상규치료적기출상채용불동방법급여미탁락이，상규가량조채용7d 가량법，쾌속적정조채용3d 가량법，량조균재체목표제량190mg/d 후，이차량유지지，관찰량조적료효。결과：①재수방기간，량조균무환자재발심기경사、심쇠이재차주원치료，몰유출현졸사등현상；②3월후문진행심장초성검사，여상규가량조비교，쾌속적정조좌실서장말내경[LVEDd，（55.00±7.56） mm 비（50.00±5.81） mm]현저강저（P ＜0.01），좌실사혈분수[LVEF，（49.13±10.18）％비（57.84±10.34）％]현저승고（P ＜0.01）。결론：쾌속적정법가이경조체도환자미탁락이적목표량，경조억제신소석방，조단신소-혈관긴장소계통，개선심기중구화심공능。
Objective:To observe and compare the therapeutic effect of metoprolol by routine increasing dose method and rapid titration method on acute myocardial infarction (AMI).Methods:A total of 60 inpatients,who were di-agnosed with AMI within 24h and without contraindications for metoprolol,were randomly divided into two groups:routine therapy group (received metoprolol using routine methods,the dose was added in seven days)and rapid ti-tration group (metoprolol was added in three days using titration).The dosage maintained with 190 mg/d after both groups reaching the target dose of 190mg/d;then therapeutic effects were observed in both groups.Results: ①There were no re-myocardial infarction,rehospitalization caused by heart failure and sudden death etc.in both groups;② Patients received echocardiography in outpatients after three months.Compared with routine increasing dose group,there was significant reduction in left ventricular end-diastolic diameter [LVEDd,(55.00±7.56)mm vs.(50.00± 5.81)mm]and significant rise in left ventricular ejection fraction [LVEF,(49.13 ± 10.18)% vs. (57.84±10.34)%]in rapid titration group,P <0.01 both.Conclusion:Rapid titration method could make the pa-tients rapidly reach the targeted dose of metoprolol and inhibit renin release earlier,block the renin-angiotensin sys-tem,and improve myocardial remodeling and cardiac function.