伊伐布雷定联合β受体阻滞剂在治疗ST段抬高型心肌梗死患者中的疗效

目的 探讨伊伐布雷定联合β受体阻滞剂治疗ST段抬高型心肌梗死(STEMI)患者的临床效果.?方法 选择2016年7月至2019年7月期间丹东市第一医院接收的78例STEMI患者,随机分为观察组和对照组,在经皮冠状动脉介入治疗(PCI)术后予以不同治疗方式,观察组予以伊伐布雷定联合美托洛尔进行治疗,对照组单纯予以美托洛尔...     

β受体阻滞剂在急性心肌梗死早期的应用

β受体阻滞剂在急性心肌梗死的治疗中占有重要的地位,多项大型临床试验均显示早期使用β受体阻滞剂可以降低心肌梗死病人的总死亡率、心血管死亡率、猝死及非致死性再梗死的发生.同时对β受体阻滞剂的保护作用的机制进行了论述.     

β受体阻滞剂在急性心肌梗死中的应用

随着循证医学的发展,β受体阻滞剂在缺血性心脏病、慢性收缩性心力衰竭、高血压等疾病中改善预后的重要临床价值已被确立,目前已成为心血管领域最常用的药物之一。然而,临床实践中,β受体阻滞剂应用仍很不够,并且使用剂量也太小。1999年在我国近2 000家医院进行的一项调查〔1〕显示,β受体阻滞剂在急性心肌梗死(AMI)和随后二级预防的使用率分别仅为43%和35%,且平均剂量仅相当于有效剂量的1/4左右。这大多源于医生对β受体阻滞剂副作用的顾虑。本文就β受体阻滞剂在AMI中的应用进行讨论。     

β受体阻滞剂治疗急性心肌梗死焦虑状况的观察

目的 探讨急性心肌梗死（AMI）患通过β受体阻滞剂治疗后对其焦虑等心理状况的影响。方法 将43例AMI患随机分为β受体阻滞剂治疗组和对照组，通过Zung抑郁自评量表（SDS）和Zung焦虑自评量表（SAS）评分了解患焦虑等状况的变化。结果 治疗组SAS评分显，低于对照组，而治疗组SDS评分与对照组比较无统计学差异。结论 β受体阻滞剂能显降低AMI病人的焦虑情绪。并不加重病人的抑郁情况。     

β—受体阻滞剂早期治疗对急性心肌梗死患者心率变异的影响

目的 研究早期使用β－受体阻滞剂对急民生心肌梗死患者心率变异的影响。方法 ４４例急性心肌梗死患者入院后随机分为β－受体阻滞剂治疗组（１８例）和对照组（２６例）。治疗组于即刻给予氨酰心安（１２．５～２５ｍｇ／天）,或美多心安（２５～５０ｍｇ／天）,余两组治疗相同,入院后１０～１４天行２４小时动态心电图检查,分别析时域指标ＳＮＤＤＳＤＡＮＮｒＭＳＳＤＰＮＮ５０,散点图指标ＶＬＩ,ＶＡＩ的变化,用配对ｔ     

急性心肌梗死病人早期口服β受体阻滞剂对住院期间心脏事件的影响

目的探讨急性心肌梗死病人早期口服β受体阻滞剂对住院期间心脏事件的影响.方法急性心肌梗死病人237例,记录病人病史、临床特点、药物治疗情况以及住院期间心脏事件的发生.结果 Logistic回归分析提示,早期使用β受体阻滞剂对于住院期间室性心律失常(OR=0.54,P=0.021)、再发心绞痛(OR=0.54,P=0.027)以及再梗死(OR=0.29,P=0.035)的发生是保护因素,早期应用β受体阻滞剂对于住院期间病死率无明显影响(OR=0.61,P=0.325).结论急性心肌梗死早期口服β受体阻滞剂可减少住院期间室性心律失常、再发心绞痛、再梗死的发生,而对于住院期间病死率无明显的影响.     

急性心肌梗死应用β-受体阻滞剂调查分析

目的 探讨基层医院在急性心肌梗死患者中应用β-受体阻滞剂的情况及使用达标率.方法 收集2003年-2007年我院收住的急性心肌梗死患者317例,剔除使用β-受体阻滞剂禁忌患者29例,并统计使用β-受体阻滞剂3 d后心率情况.结果 急性心肌梗死患者使用β-受体阻滞剂达51.74%,静息状态下3 d心室率控制在77/min.结论 基层医院对β-受体阻滞剂使用认识不足和副反应的顾虑,阻碍了循证医学证实的结论性证据在临床的应用.     

β-受体阻滞剂对陈旧性心肌梗死患者心电图Q-T离散度的影响

为观察β－受体阻滞剂对陈旧性心肌梗死的影响,本文观察了３６例高血压性心脏病患者和４２例陈旧性心肌梗死患者治疗前后Ｑ－Ｔ离散度、左心室舒张末期内径、射血分数、室性早搏及非持续性室性心动过速的变化。结果发现,治疗前两组Ｑ－Ｔ离散度、左心室舒张末期内径和射血分数无显著性差异（Ｐ〉０．０５）;而成对室性早搏、非持续性室性心动过速比较有显著性差异（Ｐ〈０．０５）,陈旧性心肌梗死组高于对照组。治疗后陈旧性心肌     

β受体阻滞剂与心力衰竭

β受体阻滞剂与心力衰竭第三军医大学西南医院彭玲综述何国祥审校本世纪以来，心衰的治疗决策经历了四个不同的阶段，尤其八十年代以来β受体阻滞剂用于治疗心衰，提高了心衰病人的远期生存率，降低了病死率。本文就β受体阻滞剂治疗心衰的理论依据和临床应用技巧综述如下...     

β受体阻滞剂褒贬不一

β阻滞剂具有抗心肌缺血作用，以及延长心脏舒张期，上调心脏β受体，抑制心肌兴奋性，抗β受体自身抗体，加强心房利钠激素与脑利钠激素，刺激内皮NO合成，抑制儿茶酚胺引起的心肌细胞消亡等等。β阻滞剂用于心衰、心肌梗死，心肌梗死后心律失常，骤死等疗效已为众所周知，但是事物总是多方面的，我们不妨来考察一下β阻滞剂的不足之处。     

Diabetic patients and beta-blockers after acute myocardial infarction

Whether diabetic patients may benefit, compared with non-diabetic patients, from beta-blocker therapy following acute myocardial infarction was examined in a large multicentre cohort of 2024 patients, including 340 diabetics, 281 of whom survived hospitalization. One-year mortality following discharge was 17% for diabetics compared with 10% for non-diabetics (P less than 0.001). However, diabetics discharged on beta-blockers had a 1-year mortality of only 10%, compared with 23% for diabetics not on beta-blockers. In non-diabetics, mortality rates were 7% and 13% for those taking and not taking beta-blockers, respectively. Bias in patient selection for beta-blocker therapy might be responsible for the trends exhibited in our population since patients were not randomized to treatment. In diabetics, evidence of pulmonary congestion on X-ray was more prevalent than in non-diabetics; this appeared to be true both for patients taking beta-blockers and for those not taking beta-blockers. However, even in diabetics without evidence of pulmonary congestion on X-ray, 1-year mortality was 7% vs 17% for those with and without beta-blocker therapy, respectively (P less than 0.04). In multivariate analysis, beta-blocker use was an independent predictor of 1-year cardiac survival following hospital discharge for all diabetics, even those without evidence for pulmonary congestion on X-ray, but not for non-diabetics. These data suggest a beneficial effect, but a definitive answer regarding the benefit of beta-blockade in diabetic patients after acute myocardial infarction would require a prospective, randomized study.     

Usefulness of universal beta-blocker therapy in patients after ST-elevation myocardial infarction

The use of beta-blockers (BB) in the context of ST-segment elevation myocardial infarction (STEMI) was a universal practice in the pre-reperfusion era. Since then, evidence of their use for secondary prevention after STEMI is scarce. Our aim is to determine treatment results associated with BB therapy after a STEMI at 1-year follow-up in a contemporary nationwide cohort.A prospective analysis involving 49 national centers, including patients admitted with STEMI, enrolled between October 2010 and September 2019 was conducted. The primary outcome was defined as the composite of all-cause mortality or hospital re-admission for a cardiovascular (CV) cause in the first year after STEMI. The patients were distributed into 2 groups, depending on whether they received therapy with BB at hospital discharge or not (BB and NB group, respectively).A total of 3145 patients were included in the analysis, of which 2526 (80.3%) in the BB group. A total of 12.2% of patients reached the primary outcome. Regarding the univariate Cox regression analysis, the BB group presented lower mortality or re-admission for CV cause at 1-year follow-up [hazard ratio (HR) 0.69, confidence interval (CI) 95% 0.55–0.87, P = .001]. However, after adjustment for significant covariates, this association was lost (HR 0.73, CI 95% 0.51–1.04, P = .081). In patients with preserved (HR 0.73, CI 95% 0.51–1.04, P = .081) and mid-range (HR 1.01, CI 95% 0.64–1.61, P = .959) left ventricular ejection fraction (LVEF), the primary outcome was similar between the 2 groups, while in patients with reduced LVEF, the BB group presented a better prognosis, with fewer patients reaching the primary outcome (HR 0.431, CI 95% 0.262–0.703, P = .001).BB universal therapy after STEMI has not proved useful, but it seems to be beneficial in patients with reduced LVEF.     

Factors associated with off-label use of drug-eluting stents in patients with ST-elevation myocardial infarction

Drug-eluting stents (DESs) are used in >80% of percutaneous coronary intervention (PCI) procedures; however, up to 2/3 are used for off-label indications. Factors associated with DES use in patients with ST-elevation myocardial infarction (STEMI) are not known in contemporary clinical practice. We analyzed temporal trends, geographic patterns, and sociodemographic factors associated with off-label use of DESs in patients undergoing primary PCI for STEMI from July 2004 to March 2006 in the National Cardiovascular Data Registry (NCDR). The main outcome of this study was receipt of any DES, and the candidate independent variables were sociodemographic, hospital, clinical, and procedural variables. We also analyzed temporal trends and geographic patterns for use of DESs. A total of 30,235 patients with STEMI underwent primary PCI with use of DESs (84%) or bare metal stents (16%). Adoption of DESs was rapid but varied widely as a function of geographic location. After adjusting for clinical and procedural variables, older age was associated with lower use (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.91 to 0.98), whereas white race (OR 1.14, 95% CI 1.03 to 1.27), commercial insurance (OR 1.22, 95% CI 1.11 to 1.34), and the west census region (OR 1.37, 95% CI 1.04 to 1.81) were associated with higher use of DESs. In conclusion, adoption of DESs was rapid in patients with STEMI, but geographic location and sociodemographic and hospital factors were associated with the use DESs.