美托洛尔与地尔硫(艹卓)对X综合征患者疗效的对比研究

目的 研究应用美托洛尔与地尔硫(艹卓)对X综合征患者的疗效.方法 收集2005年7月至2006年5月山东省医学科学院附属济宁市第一人民医院诊断的X综合征患者42例,将其随机分为美托洛尔组(20例)和地尔硫(艹卓)组(22例),随访治疗3个月后的临床情况并复查平板运动试验及冠状动脉血流储备(CFR).结果 与用药前相比,用药后2组平板运动试验到达终点时间均明显延长(P＜0.05),CFR均明显升高(P＜0.05).临床胸痛及平板运动试验阳性显著减少(P＜0.01).与地尔硫(艹卓)组相比,美托洛尔组平板运动试验中到达运动终点时间显著延长(P＜0.05),CFR显著升高(P＜0.05).结论 美托洛尔与地尔硫(艹卓)能提高心脏X综合征患者的运动耐量及CFR,美托洛尔较地尔硫(艹卓)更为有效.     

地尔硫(艹卓)联合美托洛尔治疗不稳定型心绞痛临床观察

目的:观察地尔硫(艹卓)联合美托洛尔治疗不稳定型心绞痛(UA)的疗效.方法:32例UA患者(初发劳力性心绞痛18例,恶化劳力性心绞痛14例,均合并静息性心绞痛)在基础治疗的同时,联合应用地尔硫(艹卓)口服,30～45mg/次,每日3次,美托洛尔口服,12.5～50mg,每日2次,疗程2周.观察并记录治疗前后心绞痛发作频率、程度、持续时间,硝酸甘油用量,心率,血压及12导联心电图;以ST下移导联数(NST)和ST下移总和(∑ST)表示心肌缺血范围及程度.结果:治疗前后心绞痛发作频率(次)为3.0±1.2∶0.9±0.6,持续时间(分钟)为10.6±3.2∶2.3±1.8,硝酸甘油消耗量(片/日)为2.8±1.3∶0.8±0.5,收缩压(mmHg)为140±12.6∶120±10.4,心率(次/分)为88±9.12∶70±8.6,NST为3.58±1.56∶2.12±1.10,∑ST为2.72±1.48∶1.10±0.92,差异显著(P<0.01).临床显效16例(50%),有效12例(37.50%),总有效率87.50%.结论:地尔硫(艹卓)联合美托洛尔为UA的有效治疗方法.     

地尔硫(艹卓)在肺心病心房颤动伴轻、中度心衰治疗中的应用

目的：探讨地尔硫（艹卓）对慢性肺心病快速性房颤伴轻、中度心力衰竭（CHF）病人的疗效及安全性。方法：选择75例肺心病房颤伴轻、中度CHF病人，随机分为治疗组（37例），对照组（38例）。对照组给予常规治疗．治疗组在常规治疗的基础上加用地尔硫（艹卓）50-100gg／min静脉微泵维持6～8h，1次／d，疗程为1周。结果：有效率：治疗组92％，对照组为76％，两组有显著差异（P〈0．01）；房颠转为窦律：治疗组为73％，对照组为55％（P〈0．01）。治疗中未见明显副作用。结论；地尔硫（艹卓）可用于肺心病房颤伴轻、中度CHF病人的治疗，安全、有效。     

地尔硫(艹卓)在急诊控制心房颤动快速心室率中的应用

目的观察比较静脉注射地尔硫(艹卓)、毛花甙C控制急诊心房颤动快速心室率即时疗效比较及安全性.方法71例急诊心房颤动伴快速心室率患者随机分成2组,分别静脉注射地尔硫(艹卓)或毛花甙C.结果地尔硫(艹卓)、毛花甙C二组控制心房颤动快速心室率总有效率为93.5%,72.9%;心室率平均下降幅度分别为36%、28%;平均起效时间为6.5±3.4min、24±16.5min.地尔硫(艹卓)组有2例出现一过性低血压,可自行恢复.结论静脉注射地尔硫(艹卓)10mg,10～15mg/h维持静脉滴注对心房颤动快速心室率的控制安全、迅速、有效.     

静脉应用地尔硫(艹卓)治疗老年重度心力衰竭伴房颤快速心室率的护理

快速心律失常是诱发和加重心力衰竭的常见因素之一.对心力衰竭伴房颤快速心室率的患者,快速有效地控制房颤的快速心室率,保持血流动力学稳定,是治疗心力衰竭的重要环节.     

静滴地尔硫(艹卓)治疗不稳定型心绞痛的疗效观察

目的:探讨静滴地尔硫(艹卓)(diltiazem)对不稳定型心绞痛(unstable angi-na pectoris,UAP)的疗效.方法:对32例经常规抗心绞痛治疗(变异型心绞痛14例和梗死后心绞痛18例)不能控制的夜间心绞痛患者,给予静滴地尔硫 (艹卓)30～40毫克/晚,维持8～10h,疗程7d,评价其疗效及心率和血压的变化.结果:32例的临床和心电图总有效率为90%,治疗前后心率和血压无临床意义变化.结论:静滴地尔硫(艹卓)治疗UAP疗效确切、安全,使用方便,值得推广.     

艾司洛尔、胺碘酮和地尔硫(艹卓)治疗麻醉期间快室率心房颤动的比较

目的 观察静脉注射艾司洛尔、胺碘酮和地尔硫革治疗麻醉期间快室率心房颤动(房颤)的有效性和安全性.方法 将90例快室率房颤患者随机分为艾司洛尔组(Ⅰ组)、胺碘酮组(Ⅱ组)和地尔硫革组(Ⅲ组).Ⅰ组先以艾司洛尔0.5 mg/kg负荷量于1 min内静脉注射,继之以0.05mg·kg-1·min-1静脉泵注射;Ⅱ组以胺碘酮3 mg/kg于10 min内静脉注射,继之以1 mg/min静脉泵注射;Ⅲ组以地尔硫革0.25 mg/kg于5 min内静脉注射.观察用药前及用药后5、10、15、30、60、90min患者的心室率、血压、心律;观察起效时间及不良反应.结果 起效时间Ⅰ、Ⅱ、Ⅲ组分别为(4.3±2.1)min、(19.2±8.5)min、(8.5±3.4)min,组间比较差异均有统计学意义(P＜0.05);有效率在用药后30 min内组间比较差异有统计学意义(P＜0.05),但总有效率(用药后90 min时)三组组间比较差异均无统计学意义(P＞0.05).总不良反应发生率Ⅱ组低于Ⅰ组、Ⅲ组(P＜0.05),Ⅰ组与Ⅲ组组间比较差异无统计学意义(P＞0.05).结论 艾司洛尔、胺碘酮和地尔硫革均可安全有效地治疗麻醉期间的快室率房颤,艾司洛尔起效最迅速,胺碘酮应用最安全.     

地尔硫(艹卓)在冠状动脉搭桥术后应用的疗效分析

目的:观察地尔硫革(合贝爽)对冠状动脉旁路移植术(CABG)后心率、血压的影响。方法:对68例CABG患者术后予地尔硫革维持,比较其用药前、后心率、血压的变化。结果:较之用药前,地尔硫革用药后心率的减慢和血压的下降均有显著性差异。结论:对于冠状动脉旁路移植术后患者,地尔硫革可降低心率、血压、心肌耗氧量,有利心脏康复。     

地尔硫(艹卓)对血管平滑肌细胞增殖的影响

目的观察地尔硫(Dil)对血管紧张素Ⅱ(AngⅡ)诱导的血管平滑肌细胞(VSMC)增殖的影响。方法将组织贴块法培养的大鼠胸主动脉VSMC随机分为5组,即空白组、模型组和地尔硫1、2、3组(浓度分别为10-5、10-6、10-7mol/L),应用MTT检测VSMC的增殖能力,用流式细胞术检测细胞周期构成比和增殖指数。结果各浓度的Dil都能抑制VSMC增殖(P<0.05);使VSMC的G0/G1期构成比显著升高(P<0.05);细胞增殖指数(PI)值均显著下降(P<0.05)。结论Dil具有抑制VSMC的增殖的作用。     

美托洛尔对慢性心力衰竭伴慢性心房颤动患者的作用

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AF患者106例,随机分为地高辛治疗组(54例)和美托洛尔+地高辛组(52例),观察两组1月疗效并随访1年期间因心脏原因的再住院率、死亡率。结果:治疗1月后,与地高辛组相比,美托洛尔+地高辛组静息心室率[(91.6±8.5)次/min比(72.8±9.7)次/min]和运动前后即刻心室率差值显著降低[(23.1±4.2)次/min比(12.3±4.7)次/min],6min步行距离显著增加[(256.4±90.4)m比(299.8±94.1)m],P均<0.05;随访1年,与地高辛组相比,美托洛尔+地高辛组因心力衰竭再住院率(42.6%比19.2%)、死亡率(20.4%比11.5%)明显降低,NYHA分级明显改善、6min步行距离明显增加,左室舒张末容积、左室收缩末容积明显减小,左室射血分数明显提高,生活质量明显改善,P均<0.05。结论:在常规用药的基础上,地高辛联用美托洛尔的1月疗效与1年后疗效都明显优于单用地高辛的治疗。     

步长稳心颗粒并美托洛尔对慢性心力衰竭伴心房颤动的疗效

目的:探讨步长稳心颗粒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AF98例,随机分为治疗组(50例)和对照组(48例)。两组均常规使用地高辛等常规用药,治疗组加用美托洛尔(12.5~50mg/d)及步长稳心颗粒(27g/d)。观察两组1月疗效,并随访半年心脏原因所致再住院率、死亡率。结果:治疗1月后,治疗组患者静息心室率(HR)和运动前、后即刻心室率差值(HD)显著降低,6min步行距离(m),左室射血分数(LVEF)显著增加,心功能NYHA分级,生活质量(QOL)显著改善(P<0.05~<0.01)。对照组的上述参数除HD外亦有显著改善(P<0.05),但HR、HD、6min步行距离改善显著次于治疗组(P<0.05)。随访半年,和对照组相比,治疗组患者因心力衰竭再住院率较低(14.0%∶27.1%,P<0.05),死亡率亦较低(6%∶14.6%,P<0.05);NYHA分级、6min步行距离、LVESV、LVEDV、LVEF、QOL评分明显优于对照组(P<0.05)。结论:对于慢性心力衰竭合并心房颤动患者,在常规治疗的基础上,步长稳心颗粒联用美托洛尔1个月仅HR,HD,6min步行距离改善显著优于对照组,而半年后心功能、生活质量都明显优于对照组。     

美托洛尔并地高辛对房颤伴心力衰竭患者心室率及心功能的影响

目的：观察美托洛尔联合地高辛对永久性房颤（AF）伴心力衰竭（CHF）患者心室率及运动耐量的影响。方法：选择我院心血管内科门诊及住院AF合并CHF患者共78例,随机分为两组：地高辛组（A组）39例,地高辛联合美托洛尔组（B组）39例。入选病人常规使用利尿剂、血管紧张素转换酶抑制剂、肠溶阿斯匹林（或华法令）和地高辛治疗．待病人无液体潴留,体重恒定后．B组加美托洛尔。两组病人在药物达到治疗剂量后,再予维持剂量并观察12周。两组均于人选时及治疗第12周末记录心室率,测12导联心电图,24h动态心电图（Holter）。左室射血分数（LVEF）及6min步行试验（6MWT）．评价心功能。结果：（1）Hoher检测显示A组最小、平均心室率和B组最小、平均和最大心室率在治疗后均显著降低（P均〈0．01）,B组治疗后最大、平均心室率均较A组显著降低（P〈0．01）;（2）两组病人的LVEF和6MWT治疗后均显著增加（P〈0．01）,B组治疗后较A组显著增加（P〈0．01）。无不能耐受治疗和严重并发症发生。结论：适当剂量的美托洛尔联合地高辛能控制永久性AF伴CHF患者的心室率,显著改善其心室功能,而且安全。     

Effects of metoprolol on heart rate in patients with digitalis treated chronic atrial fibrillation

Adequate control of ventricular rate in patients with chronic atrial fibrillation (AF) may not be achieved with digitalis alone. In the present study the additional effect of two different doses (50 mg and 50 + 50 mg) of oral metoprolol, a new selective β-blocking agent, on ventricular rate in patients with longstanding AF has been studied. A decrease in the mean ventricular rate during rest and during exercise at various work loads was observed after both doses. The effect was more pronounced at the highest work load of 80 W, both after 50 mg (p < 0.002) and after 50 + 50 mg (p < 0.01) of the drug. A high initial heart rate at rest or during exercise was reduced more by the drug than a lower one. Exercise tolerance was reduced in 2 patients. These results suggest that patients with AF in whom satisfactory control of heart rate cannot be achieved with digitalis alone may benefit from addition of individualized metoprolol therapy.     

Effect of diltiazem and metoprolol on left atrial appendix functions in patients with nonvalvular chronic atrial fibrillation.

OBJECTIVES: Thrombo-embolic events are the important cause of mortality and morbidity in patients with chronic atrial fibrillation (CAF). The origin of thromboembolism is often the left atrial appendix (LAA). Flow rate velocity (FRV) inside the LAA is the major determinant of thrombus formation. The aim of our study was to investigate the effects of diltiazem and metoprolol used for ventricular rate control on FRV of the LAA in CAF patients and thus to evaluate the positive or negative effects of these two drugs on thromboembolic events. METHODS: Sixty-four patients were included in the study. All patients were suffering from CAF for more than a year. The patients were allocated to two groups according with agent used for rate control- metoprolol (Group 1; n=31) and diltiazem (Group 2; n=33). Transesophageal echocardiography was applied to all patients and LAA FRV was measured by a pulse wave Doppler in the 1/3 proximal portion of the LAA. The measurements were repeated after applying 5 mg metoprolol to Group 1 and 25 mg diltiazem to Group 2 via venous cannula. RESULTS: In Group 1 after metoprolol LAA flow velocity changed from 0.25 +/- 0.90 m/s to 0.25 +/- 0.10 m/s (p>0.05). In group 2 after diltiazem left atrial appendix FRV decreased from 0.21 +/- 0.9 m/s to 0.19 +/- 0.6 m/s (p>0.05). CONCLUSIONS: In patients with CAF metoprolol used for ventricular rate control had no effect on LAA flow velocity and the observed decrease in LAA flow rate velocity with intravenous diltiazem was insignificant.     

Effects of lisinopril in patients with heart failure and chronic atrial fibrillation

Although atrial fibrillation is common in patients with heart failure, patients with atrial fibrillation are often excluded from congestive heart failure trials or are not analyzed separately. Consequently, while the effect of angiotensin-converting enzyme inhibitors in patients with sinus rhythm is well established, the effect on patients with atrial fibrillation is unknown. The authors hypothesized that these agents might be particularly effective in this patient category, given their antiadrenergic properties and the importance of adequate rate control. Therefore, the effects of lisinopril 10 mg once daily were evaluated in 30 patients with congestive heart failure and chronic atrial fibrillation (mean age, 68 +/- 6 years) in a double-blind, randomized, placebo-controlled trial. All patients were in New York Heart Association class II or III and were stable on conventional therapy (digoxin, diuretics, nitrates). After 6 weeks, mean peak oxygen consumption increased from 14.7 +/- 3.4 to 15.9 +/- 2.9 mL/min/kg in the lisinopril group (P = .034). Plasma norepinephrine levels during exercise and at peak exercise tended to be lower when the patients were taking lisinopril (10.8 +/- 4.2 to 8.9 +/- 4.4 nmol/L and 16.3 +/- 9.2 to 14.3 +/- 7.7 nmol/L, P < .1). Heart rate during exercise and ambulatory monitoring was not significantly affected. Left ventricular fractional shortening tended to increase after lisinopril (23 +/- 7 to 27 +/- 9%, P = .073). Left atrial volume was unchanged, as were plasma atrial natriuretic peptide levels. After subsequent electrical cardioversion, treatment was continued for 6 more weeks, allowing assessment of the effect of lisinopril on maintenance of sinus rhythm; maintenance of sinus rhythm was 71% in the lisinopril group and 36% in the placebo group (P = NS). This study shows that treatment with an angiotensin- converting enzyme inhibitor improves peak oxygen consumption in patients with congestive heart failure and chronic atrial fibrillation. Attenuation of adrenergic drive during exercise may play a role in mediating this effect.     

倍他乐克联合地高辛对心衰并房颤患者心功能和心室率的影响

目的:观察倍他乐克联合地高辛对慢性心力衰竭合并心房纤颤患者心功能和心室率的影响。方法:选择慢性心力衰竭合并快速房颤患者62例,随机分成2组。在综合治疗1周后,治疗组32例采用倍他乐克 地高辛治疗;对照组30例,采用地高辛治疗。8周后观察心功能和心室率变化的情况。结果:倍他乐克 地高辛治疗组改善心功能和控制心室率的疗效明显强于地高辛组(P均<0.05)。结论:倍他乐克 地高辛能够改善慢性心力衰竭合并心房纤颤患者的心功能,有效地控制患者较快的心室率,并且安全性高,是其治疗的有效方法。     

静脉注射美托洛尔、地尔硫卓治疗快速心房纤颤的临床疗效观察

目的:观察美托洛尔注射液和地尔硫卓注射液治疗快速房颤的有效性和安全性。方法:105例符合入选标准的快速房颤患者被随机分为3组,美托洛尔组39例:5mg美托洛尔缓慢静脉注射,观察5min,如无效重复一次,连续用药3次,总量15mg;地尔硫卓35例:地尔硫卓15mg稀释后静脉注射,观察15min,如无效重复1次,继以15mg/h维持。西地兰组31例:西地兰0.2～0.4mg稀释后静脉注射,观察10min,如无效追加0.2～0.4mg,连续用药3次;总量0.6～1.0mg。记录用药前、后心室率和血压变化,并比较在各观察时间点上的有效率。结果:与西地兰相比,美托洛尔和地尔硫卓起效更快[(36.9±11.6)min∶(8.2±4.5)min∶(9.1±3.8)min,P<0.05],心室率下降幅度更明显(25.22%∶33.32%∶37.50%,P<0.05),治疗有效率更高(71.0%∶89.7%∶91.4%,P<0.05)。而美托洛尔组和地尔硫卓组之间无显著性差异。三组均无严重不良反应发生。结论:美托洛尔注射液和地尔硫卓注射液均能快速、安全、有效控制快速房颤的心室率。     

Impact of atrial fibrillation on mortality in patients with chronic heart failure

Chronic heart failure and atrial fibrillation often occur together. The aim of the study is to review the available literature on the impact of atrial fibrillation on mortality in patients with heart failure. Using MEDLINE six full papers were identified. In the studies with severe heart failure atrial fibrillation did not emerge as an independent predictor of mortality beyond standard clinical variables. In contrast, atrial fibrillation was associated with increased mortality in case of mild-to-moderate heart failure.