胺碘酮联合美托洛尔静脉注射治疗快速型心律失常的临床观察

目的对胺碘酮联合美托洛尔静脉注射治疗快速心律失常的临床疗效进行观察研究。方法随机抽取2013年8月~2014年6月本院接诊的80例快速心律失常患者,按照数字表法随机分为观察组与对照组,对照组予以胺碘酮治疗,观察组加用美托洛尔,观察两组临床疗效、治疗前后血压、心率变化情况及不良反应发生情况。结果观察组临床治疗有效率95.0%(38/40)优于对照组70.0%(28/40),组间比较差异有统计学意义(χ2=6.441,P0.05);治疗前,两组患者血压、心率无明显差异(P0.05),治疗后观察组低于对照组,组间比较差异有统计学意义(P均0.05);观察组患者不良反应发生率总计7.5%与对照组5.0%比较差异无统计学意义(P0.05)。结论胺碘酮联合美托洛尔静脉注射治疗快速心律失常疗效确切,且未增加患者的药物不良反应,具有非常积极的临床应用价值。     

稳心颗粒加美托洛尔治疗快速型心律失常疗效观察

2004年6月-2005年6月，我院采用中药稳心颗粒加美托洛尔治疗快速型心律失常患者56例，与单用美托洛尔治疗者比较疗效明显。现报告如下。     

胺碘酮联合美托洛尔治疗心律失常的效果分析

目的 分析胺碘酮联合美托洛尔治疗心律失常的效果。方法 选取2021年1月至2021年9月我院收治的心律失常患者100例,按照随机数字表法分为对照组和试验组,对照组给予胺碘酮进行治疗,试验组给予胺碘酮与美托洛尔联合进行治疗。观察和比较两组患者临床治疗效果。结果 治疗后,试验组患者治疗效果优于对照组,生活质量各项得分明显高于对照组,治疗总满意度显著高于对照组,左心室舒张末期内径及心率均优于对照组,差异有统计学意义（P <0.05）。结论 采用胺碘酮联合美托洛尔治疗心律失常具有显著的临床效果,可有效改善患者临床症状、促进心功能恢复、提升生活质量、提高患者对治疗的满意度,临床上值得推广。     

胺碘酮联合美托洛尔治疗快速心律失常疗效观察

目的探索研究胺碘酮联合美托洛尔治疗快速心律失常的临床疗效。方法从我院2013-2014年的快速心律失常的患者中随机选取72名患者作为研究对象,再将这72名患者随机的分成两组:对照组和观察组,对照组采用单纯的胺碘酮治疗,观察组采用胺碘酮联合美托洛尔治疗,观察对比两组患者治疗前后的心率、血压,对比两组患者治疗后的临床疗效(总有效率和转复率)和不良反应。结果两组患者在治疗后的平均心率,收缩压和舒张压均有明显的下降(P0.05),而观察组下降的幅度比对照组明显要多,也更趋于正常(P0.05)。治疗后对照组转复率为75.00%,总有效率为77.78%,观察组转复率为88.89%,总有效率为91.67%,观察组的总有效率和转复率明显比对照组高(P0.05)。对照组治疗后平均起效时间为(6.79±0.84)h,观察组治疗后平均起效时间为(0.87±0.46)h,观察组的起效时间明显比对照组短(P0.05)。两组患者均无不良反应出现,在不良反应上两组患者无差异(P0.05)。结论单纯胺碘酮治疗与胺碘酮联合美托洛尔治疗在临床上的安全性均良好,不良反应少;但胺碘酮联合美托洛尔治疗可以明显提高临床疗效,而且起效时间短。在临床上治疗快速心律失常的患者时可以优先考虑胺碘酮联合美托洛尔使用。     

胺碘酮联合美托洛尔治疗心律失常的临床疗效分析

目的探讨心律失常患者采用美托洛尔联合胺碘酮治疗的临床效果。方法随机将2016年1月-2018年1月期间我院收治的126例心律失常患者分为两组,其中对照组采用单一胺碘酮治疗,而观察组在此基础上,再应用美托洛尔联合治疗,对比两组效果。结果观察组的治疗有效率高于对照组(P<0.05);同时,两组的起效时间和心率比较有差异(P<0.05)。结论临床上运用美托洛尔与胺碘酮联合治疗心律失常具有较好的效果。     

归脾汤加减治疗心律失常的Meta分析

目的运用Meta分析评价归脾汤治疗心律失常的有效性及安全性。方法通过计算机检索中国知网(CNKI)、中国生物医学文献数据库、万方数据库,时间截至2017年1月。收集归脾汤加减治疗心律失常的随机对照试验/半随机对照试验文献,按纳入和排除标准由2名评价者独立选择试验、提取资料,交叉核对并进行文献质量评价,最后纳入研究的文献使用RevMan5.3软件进行Meta分析。结果共纳入9项研究,均为中文文献,总计772例病人。Meta分析结果显示:归脾汤加规范西药治疗心律失常在临床疗效及心电图改善方面优于规范西药治疗[RR=1.28,95%CI(1.18,1.40),P0.000 01;RR=1.30,95%CI(1.19,1.41),P0.000 01]。结论归脾汤加减联合使用西药治疗效果优于单用西药治疗。     

稳心颗粒联合美托洛尔对老年冠心病心律失常患者疗效与安全性的Meta分析

目的系统评价稳心颗粒联合美托洛尔治疗老年冠心病心律失常患者的效果和安全性。方法检索中国知网、万方、维普、CBM、Cochrane Library、Web of Science、PubMed及EMbase,系统检索稳心颗粒联合美托洛尔治疗老年冠心病心律失常患者的随机对照试验至2020年10月1日。由2位评价员按纳入、排除标准筛选文献后,使用Revman5.4.1进行Meta分析,评价临床总体疗效、临床症状改善率、心电图改善率、不良反应发生情况、治疗前后房性早搏、室性早搏、交界性早搏、短阵室速、ST段降低、ST段降低持续时间变化。结果共纳入24篇文献、2185例患者。稳心颗粒联合美托洛尔在临床总体疗效改善[OR=4.88,95%CI(3.35,7.11),P<0.00001]、心电图改善[OR=3.96,95%CI(2.24,7.01),P<0.00001]、临床症状改善[OR=8.72,95%CI(5.12,14.87),P<0.00001]、减少房性早搏[SMD=-2.19,95%CI(-3.16,-1.22),P<0.0001]、减少室性早搏[SMD=-1.99,95%CI(-2.96,-1.02),P<0.00001]、减少交界性早搏[SMD=-1.25,95%CI(-1.91,-0.59),P=0.002]、减少短阵室速[SMD=-2.30,95%CI(-3.58,-1.03),P=0.0004]、ST段降低[SMD=-1.39,95%CI(-2.53,-0.26),P=0.02]、ST段降低持续时间[SMD=-1.12,95%CI(-1.37,-0.87),P<0.00001]等方面均优于单用美托洛尔,药物不良反应[OR=0.55,95%CI(0.36,0.85),P=0.007]低于单用美托洛尔。结论稳心颗粒联合美托洛尔较单用美托洛尔在治疗老年人冠心病心律失常方面疗效显著,可明显改善患者临床症状及动态心电图表现,且不良反应较少。     

美托洛尔联合步长稳心颗粒治疗心律失常的临床疗效

目的评价美托洛尔联合步长稳心颗粒治疗心律失常的疗效。方法将215例心律失常的患者随机分为3组：治疗组（A组）71例,给予口服美托洛尔12.5mg/次,2次/d,稳心颗粒9g/次,3次/d;对照组分为B组和C组,B组72例,口服美托洛尔12.5mg/次,2次/d;C组72例,口服稳心颗粒9g/次,3次/d。疗程均为4周,治疗前后均做心电图及动态心电图检查,以判断疗效并作对比分析。结果治疗4周后,美托洛尔联合步长稳心颗粒治疗组的有效率为91.5%,明显优于单用美托洛尔及步长稳心颗粒对照组,差异有统计学意义（P〈0.05）。结论美托洛尔联合步长稳心颗粒治疗心律失常疗效满意,不良反应少,具有明确的临床意义。     

胺碘酮联合美托洛尔治疗心律失常的临床疗效分析

目的：探讨胺碘酮联合美托洛尔治疗心律失常患者的临床疗效。方法选取我院在2009年1月至2012年12月收治的因各种心血管系统疾病导致的心律失常患者80例,将所有患者随机分为观察组和对照组,对照组单独应用胺碘酮治疗,观察组联合应用胺碘酮和美托洛尔治疗,对两组的治疗效果进行比较。结果疗效的比较,观察组总有效率和心律转复率明显大于对照组,达到有效率的平均时间明显小于对照组,且差异均具有统计学意义P〈0.05;治疗前后心率和血压的比较,治疗前两组无明显差异P〉0.05,治疗后观察组心率和血压值明显小于对照组,P〈0.05;不良反应的比较无明显差异P〉0.05。结论联合应用胺碘酮和美托洛尔治疗心率失常患者可显著提高疗效,快速改善患者的临床症状,且无安全有效,值得临床推广。     

美托洛尔注射剂治疗快速房性心律失常的临床研究

目的观察静脉应用美托洛尔控制快速性房性心律失常心室率的有效性及安全性。方法30例快速性房性心律失常、心室率>120次/分的患者随机分为美托洛尔组和西地兰组。观察用药前(0min)、第二剂前、第三剂前;首剂用药后40,60,90min和120min时的心率和血压。用药后心室率降至100次/分以下或转复窦性心律为有效。结果30例快速性房性心律失常(心房颤动20例,心房扑动5例,房性心动过速5例)患者,男17例,女13例,年龄57.3±12.4岁,随机分入美托洛尔组和西地兰组。在60min内各观察时间点,美托洛尔组明显优于西地兰组,两组有效率分别为53.3%、86.7%、93.3%和93.3%对13.3%、20.0%、40.0%和60.0%。两组平均起效时间美托洛尔组为12.6±6.7min和西地兰组为53.0±28.4min,美托洛尔组明显短于西地兰组。120min内两组总有效率分别为93.3%、80%,无显著差异。结论静脉应用美托洛尔及西地兰均能有效安全地控制快速性房性心律失常的心室率,美托洛尔起效较西地兰更快。     

美托洛尔治疗高血压临床观察

40例高血压病患者服用美托洛尔8周，显效率和总有效率分别为60％和82．5％，其中Ⅰ，Ⅱ期高血压病患者疗效更好，无严重副作用，该药可作为Ⅰ，Ⅱ期高血压病的首选药物之一。     

稳心颗粒联合美托洛尔治疗冠心病心律失常有效性及安全性的系统评价

目的系统评价稳心颗粒联合美托洛尔治疗冠心病心律失常的有效性及安全性。方法通过计算机检索中国知网、万方数据库、维普信息资源系统、PubMed、Web of Science及Cochrane Library等数据库,时间为建库至2019年6月,收集有关稳心颗粒联合美托洛尔治疗冠心病心律失常的临床随机对照试验。由两位评价员对纳入的研究进行资料提取和质量评价,并采用RevMan 5.3软件进行统计学分析。结果纳入的32篇研究共3383例病人。Meta分析结果显示,稳心颗粒联合美托洛尔治疗冠心病心律失常在临床总有效率[RR=1.21,95%CI(1.18,1.25),P<0.00001]、室性期前收缩次数[SMD=-4.40,95%CI(-5.64,-3.17),P<0.00001]、房性期前收缩次数[SMD=-4.27,95%CI(-5.78,-2.77),P<0.00001]、ST段压低程度[MD=-0.36,95%CI(-0.41,-0.31),P<0.00001]、ST段压低持续时间[MD=-0.73,95%CI(-0.82,-0.65),P<0.00001]、不良反应发生率[RR=0.69,95%CI(0.55,0.87),P=0.002]方面,均优于单用美托洛尔,差异均有统计学意义。结论当前证据表明,与单用美托洛尔比较,稳心颗粒联合美托洛尔治疗冠心病心律失常,可提高临床疗效,并且安全性更佳。     

Tolerability to Treatment with Metoprolol in Acute Myocardial Infarction in Relation to Age

ABSTRACT A double-blind trial with the β₁-selective blocker metoprolol in suspected acute myocardial infarction and during 3 months' follow-up included 1 395 patients, aged 40–74 years, 698 on metoprolol and 697 on placebo. In order to further evaluate the tolerability to β-blockade in the elderly, the total series was divided into 2 groups according to median age (61 years) and into quartiles, the lowest quartile (40–57 years) being compared with the highest (67–74 years). The decrease in heart rate and systolic blood pressure after intravenous metoprolol in the acute phase was similar in the elderly and the younger patients. Hypotension was observed more often in the metoprolol-treated than in the placebo-treated younger patients, while no difference was observed in the elderly. Bradycardia was observed more often in the motoprolol group in both age groups, while there was no difference regarding the incidence of congestive heart failure in either the younger or in the elderly patients. The effect on mortality, serious ventricular arrhythmias and chest pain seemed to be similar in different age groups. From the present series we conclude that hemodynamic reactions and tolerability to β-blockade can be expected to be similar in elderly and younger patients.     

美托洛尔治疗高血压对血脂及糖代谢的影响

对37例原发性高血压患者进行美托洛尔治疗前后心率、血压、总胆固醇、甘油三酯、糖耐量试验、胰岛素、24h尿钾、钠、钙、肌酐测定，结果表明：服用美托洛尔后心率、血压下降，尿钠排泄增加，糖负荷曲线略增高，胰岛素水平及胰岛素抗性（ISR）降低（P＜0．01），血脂无改变（P＞0．05）。提示美托洛尔对原发性高血压Ⅰ，Ⅱ期者，在改善血压、心率同时，不影响脂肪代谢，可增加尿纳排泄，对糖代谢、胰岛素及胰岛素抵抗影响较小。     

Reduction of Nonfatal Reinfarctions in Patients with a History of Hypertension by Chronic Postinfarction Treatment with Metoprolol

ABSTRACT The Stockholm Metoprolol Trial is a prospective double-blind placebo-controlled postmyocardial infarction study of 301 patients treated with metoprolol, 100 mg b.i.d., or matching placebo for three years. From this study we have retrospectively evaluated the outcome in patients with a history of treatment for hypertension prior to the index infarction. There were 41 such patients in the placebo group and 35 in the metoprolol group. Blood pressures during follow-up were nearly identical in the two groups. During the three years 11 patients died in the placebo group and 7 in the metoprolol group. Corresponding figures for nonfatal events such as reinfarction, coronary artery bypass surgery, cerebrovascular events and lower limb amputation were 12 vs. 1 (p<0.005), 3 vs. 0, 4 vs. 0 and 1 vs. 0, respectively. The numbers of patients with fatal and nonfatal events were 24 vs. 8 (p<0.01). In a retrospective subgroup analysis the results must always be interpreted with caution. The present results may, however, imply that postinfarction treatment with metoprolol reduces nonfatal atherosclerotic complications, especially nonfatal reinfarctions, in patients with a history of hypertension.     

ADP-induced Platelet Aggregation and Metoprolol Treatment of Myocardial Infarction Patients

ABSTRACT The effect of metoprolol on platelet aggregation was investigated in a group of postmyocardial infarction (MI) patients. The study was double-blind and included 63 subjects; 30 patients were maintained on metoprolol and 33 received placebo treatment. Adenosine diphosphate (ADP)-induced platelet aggregation was carried out in each subject close to 4 weeks after the acute MI. It was demonstrated that metoprolol as compared to placebo did not influence ADP-induced platelet aggregation in the present clinical setting.     

A Trial of Metoprolol in Hypertensive Insulin-Dependent Diabetic Patients

ABSTRACT. Twenty-four insulin-dependent, hypertensive diabetic patients were treated with a β₁-selective blocking agent (metoprolol) to evaluate its influence on diabetic state and arterial blood pressure (BP). Two groups were delineated after exclusion of one patient. Twelve patients (group A) obtained normotension with metoprolol alone, whilst 11 (group B) required concomitant treatment with thiazides, 7 of them both with thiazides and hydralazine. BP fell significantly in group B, by 15% (p<0.01), compared with pretreatment levels. Postprandial blood glucose levels, glucose excretion and insulin requirements were unchanged during treatment in all patients. Neither quantitative nor qualitative changes in the recognition of the effects of insulin were observed by 15 diabetics familiar with this sensation. Side-effects were few. One episode of severe hypoglycaemia, probably unrelated to the β-blockade, was encountered. We suggest that antihypertensive treatment with metoprolol is a reasonable alternative in the treatment of hypertensive insulin-dependent diabetic patients.     

银丹心脑通软胶囊治疗高脂血症合并糖尿病的Meta分析

目的系统评价银丹心脑通软胶囊治疗高脂血症合并糖尿病的疗效。方法计算机检索Cochrane图书馆、PubMed、EMbase、MedLine、CNKI、CBM、VIP、万方等数据库,纳入相关随机对照试验(RCT),进行质量评价,采用RevMan5.3软件分析数据。结果纳入8篇RCTs,共1272例受试者。与对照组比较,试验组血脂总疗效较高[RR=1.27,95%CI(1.16,1.39),P<0.00001],总胆固醇(TC)水平低于对照组[WMD=-1.32,95%CI(-1.74,-0.90),P<0.00001],三酰甘油(TG)水平低于对照组[WMD=-0.62,95%CI(-0.79,-0.45),P<0.00001],高密度脂蛋白胆固醇(HDL-C)水平高于对照组[WMD=0.32,95%CI(0.27,0.37),P<0.00001],低密度脂蛋白胆固醇(LDL-C)水平低于对照组[WMD=-0.65,95%CI(-0.83,-0.47),P<0.00001];试验组空腹血糖水平低于对照组[WMD=-1.27,95%CI(-1.54,-1.00),P<0.00001],餐后2h血糖水平低于对照组[WMD=-3.67,95%CI(-5.07,-2.28),P<0.00001],糖化血红蛋白水平低于对照组[WMD=-1.89,95%CI(-3.13,-0.64),P=0.003]。结论银丹心脑通软胶囊治疗高脂血症合并糖尿病疗效明显,能够有效改善血脂、血糖,对合并二甲双胍亚组TC、LDL-C、空腹血糖及合并常规治疗亚组的空腹血糖疗效相对确切。     

美托洛尔对高血压患者生活质量的影响

目的观察美托洛尔治疗对患者生活质量的影响。方法７４例高血压患者服用美托洛尔８周，通过８项生活指标观察患者在治疗过程中影响。结果美托洛尔降压治疗显效率、总有效率分别为６１．２％及７８．４％，其中Ｉ、Ⅱ期高血压疗效更好。生活质量评定显示，经８周治疗患者在躯体症状、工作能力、生活满意感及业余生活等方面均有显著改善（Ｐ＜０．０５～０．０１）。结论美托洛尔在降压治疗同时可明显改善患者生活质量     

The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysis

Objective

Supraventricular tachyarrhythmias including atrial fibrillation are common and troubling complications after cardiac surgery, and thus considerable interest in pharmacologic prophylaxis has developed. The aim of this study was to evaluate the efficacy of sotalol in the prevention of postoperative supraventricular tachyarrhythmias.

Methods

Standard methods of meta-analysis were used. Randomized clinical trials published in English language were eligible for the meta-analysis.

Results

A systematic review revealed 15 eligible publications that provided 20 comparisons of sotalol with a control group. The incidence and relative risk (RR) with 95% confidence interval (CI) of developing postoperative supraventricular tachyarrhythmias while taking sotalol were sotalol (n = 489) versus placebo (n = 499): 22.5% versus 41.5%, RR = 0.55 (CI, 0.454-0.667, P < .001); sotalol (n = 304) versus no treatment (n = 311): 12% versus 39%, RR = 0.329 (CI, 0.236-0.459, P < .001); sotalol (n = 488) versus beta-blocker (n = 555): 14% versus 23%, RR = 0.644 (CI, 0.495-0.838, P < .001); sotalol (n = 139) versus amiodarone (n = 146): no significant differences in supraventricular tachyarrhythmia prevention; and sotalol (n = 51) versus magnesium (n = 54): no significant differences in supraventricular tachyarrhythmia prevention. Initiating sotalol orally or intravenously had no significant effect on efficacy. Initiating sotalol after surgery showed a trend toward less adverse events (before: RR = 1.700 [CI, 0.903-3.200] and after: RR = 0.767 [CI, 0.391-1.505]).

Conclusion

Sotalol is more effective in the prevention of supraventricular tachyarrhythmia than placebo or beta-blockers. Initiating sotalol before cardiac surgery has no advantage compared with initiating sotalol shortly after surgery. Starting sotalol intravenously after surgery may be a more reliable method than administering via a nasogastric tube or delaying treatment until the patient can take oral medication.