美托洛尔对慢性心力衰竭伴慢性心房颤动患者的影响

目的探讨地高辛联用美托洛尔对慢性心力衰竭(CHF)伴慢性心房颤动(AF)患者的疗效。方法选择CHF伴慢性AF106例,随机分为美托洛尔组(美托洛尔加常规治疗52例)和常规组(54例),2组均常规使用地高辛、利尿剂、血管紧张素转换酶抑制剂(ACEI)、抗凝剂,观察2组疗效并随访1年期间因心脏原因的再住院率、死亡率。结果治疗1个月后,美托洛尔组显著降低静息心室率(HR)和运动前后即该心室率差值(HD)及增加6min步行距离(S),显著改善心功能NYHA分级,增加左室射血分数(LVEF),显著改善生活质量(QOL);常规组显著降低HR,但降低HD不明显,增加S,改善心功能NYHA分级,LVEF增加,也能改善QOL。随访1年,美托洛尔组和常规组相比,因心力衰竭再住院率较低(19.2%vs42.6%,p<0.05)死亡率亦较低(11.5%vs20.4%,p<0.05),两组存活的病例,常规组NYHA分级、S、LVEDV、LVEDV、LVEF、QOL评分与美托洛尔组相比,明显恶化(p<0.05)。结论在常规使用利尿剂、ACEI、抗凝剂治疗的基础上,地高辛联用美托洛尔其1个月疗效与单用地高辛相近,但1年后疗效却明显优于单用地高辛。

EFFECTS OF METOPROLOV WITH DIGOXIN ON CHRONIC HEART FAILURE(CHF) PATIENTS WITH CHRONIC AT-RIAL FIBRILLATION(AF)

Objective To investigate the effects of metoprolol with digoxin on chronic heart failure(CHF) patients with chronic at-rial fibrillation(AF).Methods One hundred and six CHF with AF patients were divided into the metoprolol treatment group(52cases)and the control group(54cases) randomly. The general therapy included digoxin,diuretics,angiotensin converting enzyme inhibitors(ACEI)and anticoagulants. The short-term effects in 1 month and the rehospitalization rate and the mortality rate within 1 years were compared in two groups. Results The ventricular rate at rest(HR) decreased obviously(p<0.01) and the distance of 6 minute walk(S) and the NYHA heart function classes and score of quality of live(QOL)improved obviously(p<0.05)and left ventricular ejection fraction(LVEF) increased obviously(p<0.05)in two groups 1 month after admission. But the diversity of ventricular rate before and after walk(HD)was decreased more in metoprolol group than that in control group(p<0.05).The rehospitalization rate was 19.2% in the metoprolol group and 42.6% in control group(p<0.05)because of deterioration in heart function within 1 years. The mortality rate was 11.5% in the metoprolol group and 20.4% in control group(p<0.05)for a 1- year follow-up period.After 1 years,S,the NYHA heart function classes, score of QOL,LVEF,the left ventricular end systolic volume(LVESV) and the left ventricular end diastolic volume(LVEDV) were deteriorated in control group than that in metoprolol guoup(p<0.05).Conclusion Based on the medication of diuretics,ACEI and anticoagulants,both digoxin with metoprol-ol and without metoprolol therapy can improve the short-term effects on CHF with AF patients,but the long-term prognosis of digoxin with metoprolol therapy in CHF with AF patients is better than that of digoxin without metoprolol therapy.