美托洛尔在反复心肌梗死中的应用

目的 了解反复心肌梗死在开始治疗时心率对美托洛尔的疗效影响.方法 急性心肌反复梗死病人48例,根据开始治疗时心率分成两组,第1组在心率达到75次/分开始口服美托洛尔12.5 mg,每日2次;第2组在心率达到100次/分开始口服美托洛尔12.5 mg,每日1次.结果 第1组采用美托洛尔治疗的病人24 h内疼痛症状缓解率优于第2组,但差异无统计学意义(P＞0.05);第1组1个月内病死率和1年内病死率低于第2组,差异有统计学意义(P＜0.05).结论 小剂量美托洛尔早期干预治疗对病人短期和长期预后均有好处.     

早期应用大剂量美托洛尔治疗老年急性心肌梗死的疗效

美托洛尔是一种β受体阻滞剂,可选择性抑制心脏β1受体,从而可以有效控制心肌梗死患者的临床症状,明显改善心肌梗死患者的预后[1,2],因此在治疗急性心肌梗死中具有重要的临床价值.但是因为老年急性心肌梗死病人身体机能显著衰退,各脏器功能下降,药物的吸收和排泄及药效等方面与青年人差异较大.本研究拟探讨早期应用大剂量美托洛尔治疗老年急性心肌梗死的疗效及安全性.     

院前应用美托洛尔救治急性心肌梗死病人的观察

目的探讨院前应用美托洛尔静脉直接推注治疗急性心肌梗死的可行性.方法28例急性心肌梗死病人,院前治疗在现场直接静脉推注.结果所有病例均有效.结论在急性心肌梗死发病最短时间内,足量用药,疗效迅速、明确.     

美托洛尔对急性心肌梗死患者自主神经的影响

目的研究美托洛尔对急性心肌梗死(AMI)患者自主神经失衡的影响。方法AMI患者62例,随机分为两组,美托洛尔组(A组)32例,对照组(B组)30例。结果美托洛尔治疗后心率变异频域指标明显改善,P<0.01。住院期间A组心绞痛发作次数、静滴硝酸甘油剂量、用镇痛药的频率及泵衰竭的发生率较B组减少(P<0.01)。随访36个月,A组发生不稳定性心绞痛、再发心肌梗死、心力衰竭、心脏性死亡均较B组少(P<0.01)。结论美托洛尔治疗AMI,可明显增加心率变异性,维持自主神经平衡,有助于预防再发梗死、心脏性猝死,改善预后。     

美托洛尔对急性心肌梗死的心率变异影响

近年来 ,心率变异 (ＨＲＶ)被认为可以较好的提示急性心肌梗死 (ＡＭＩ)的预后[1、2 ] ,ＨＲＶ变小 ,猝死的危险性增大。多中心临床观察证明 ,ＡＭＩ患者使用 β受体阻滞剂 ,可缩小梗死范围 ,改善心功能 ,控制或减少心律失常 ,有利近期和远期预后[3] 。但这种作用与ＨＲＶ的关系报道不多 ,我们观察了ＡＭＩ患者应用美托洛尔后ＨＲＶ的变化 ,现报告如下。1　资料与方法患者均为ＡＭＩ住院者 ,治疗 (Ａ)组3 0例 ,其中男 2 1例 ,女 9例 ,年龄 3 8～ 74(60± 10 1)岁 ;对照 (Ｂ)组 3 0例 ,其中男2 2例 ,女 8例 ,年龄 3 9～ 76(61± 9 8)岁。除…     

小剂量美托洛尔防治大鼠急性心肌梗死左心室重构的研究

目的探讨小剂量美托洛尔(metoprolol)防治大鼠急性心肌梗死(AMI)左心室重构(LVRM)的作用.方法70只雌性AMI大鼠随机分成AMI对照组(n＝35)和小剂量美托洛尔[2mg/(kg·d)]组(n＝35).另设假手术组(n＝16)做对照.给药4周后行血流动力学测定和病理分析.结果AMI对照组与假手术组相比,左心室舒张末压、容积、重量以及室间隔厚度均增加,有极显著性差异(P均＜0.001),左心室内压最大上升和下降速率(±dp/dtmax)及其左心室收缩压的校正值(±dp/dt/LVSP)均显著降低,有极显著性差异(P均＜0.001).小剂量美托洛尔组与AMI对照组相比,左心室舒张末压和容积均显著降低,有极显著性差异(P＜0.01～0.001),球形指数和±dp/dtmax及±dp/dt/LVSP均显著增加,有极显著性差异(P＜0.05～0.001),而室间隔厚度和左心室重量均无显著差异(P均＞0.05).结论小剂量美托洛尔能有效防治大鼠AMI左心室扩张,改善血流动力学和左心室功能,但似不能抑制左心室肥厚.     

美托洛尔治疗急性心肌梗死的临床观察

目的观察静脉给予美托洛尔(倍他乐克)治疗急性心肌梗死的疗效.方法急性心肌梗死病人10例,无美托洛尔禁忌证,5 mg静脉推注,观察2 min～5 min,连续3次,50 mg口服,每6 h 1次,共48 h,之后100 mg,每日2次口服.结果 10例病人心率由(105±15)/min降为(80±10)/min,收缩压由(140±10)mmHg降为(120±15)mmHg,心率×收缩压由(14 700±230)降为(9 600±200),无严重心动过缓及Ⅱ度、Ⅲ度房室传导阻滞,心功能恶化及死亡等事件.结论静脉给予美托洛尔治疗急性心肌梗死有一定疗效,且较安全.     

美托洛尔对大鼠心肌梗死后心力衰竭的保护作用

目的:研究美托洛尔对大鼠心肌梗死后心力衰竭的保护作用及其可能机制. 方法:结扎大鼠左冠状动脉制备心力衰竭大鼠模型,将大鼠随机分为伪手术组、模型组和美托洛尔(10 mg·kg-1·d-1)处理组,并给药6周.6周后进行血流动力学检查,观测心肌细胞凋亡情况以及凋亡相关因子Bcl-2、Bax的表达. 结果:美托洛尔能明显改善心功能;减少心肌细胞凋亡;抑制Bcl-2表达,促进Bax表达. 结论:美托洛尔对心肌梗死后心力衰竭具有一定的保护作用,其部分机制可能是通过抑制心肌细胞凋亡实现的.     

Gallopamil Activity on Asynergic Viable Myocardium in Acute Myocardial Infarction: Insights on Stunned and Hibernating Myocardium

The influence of the calcium antagonist gallopamil on the contractility of asynergic viable myocardium after acute myocardial infarction treated with thrombolysis was investigated by two-dimensional echocardiography. Sixteen patients with 1 viable segment(s), identified during the low-dose phase (up to 10 g/kg/min) of a dobutamine echocardiographic test (up to 40 g/kg/min) performed 4–5 days after a first acute myocardial infarction, were given a gallopamil intravenous bolus (50 g/kg) 12–24 hours later. Two-dimensional echocardiography was done before and 15 minutes after the bolus. A score index of 1 (normokinesis) to 4 (dyskinesis) and a 16-segment model were used. A segment was considered viable when a resting asynergy (score 2) improvement of 1 grade was seen during low-dose dobutamine. Follow-up echocardiograms were done 3–5 months later. A total of 30 viable segments were found; of these, 10 showed sustained improvement in contractility (group A) during high-dose dobutamine, while 20 exhibited a biphasic response returning to their basal contractile state (group B). After the gallopamil bolus, 9 of 10 group A segments improved their contractility, in comparison with 0 of 20 group B segments (P < .001). Infarct-related vessel significant (75%) coronary stenosis was present in the tributary vessel of 0 of 10 group A and of 20 of 20 group B segments (P < .001). At follow-up, 9 of 10 group A segments showed a spontaneous contractile improvement; of the 20 group B segments, 8 of 10 that underwent revascularization (7 angioplasty, 3 bypass graft) showed contractile improvement, in comparison with 0 of 10 segments not revascularized (P = .001). We conclude that gallopamil may reverse the contractile dysfunction of postischemic stunned myocardium in patients with acute myocardial infarction, whereas no effects are apparent on ischemic/hibernating myocardium.     

倍他乐克、洛汀新对心肌梗死后自主神经调控的影响

为评价倍他乐克、洛汀新对急性心肌梗死 (AMI)后自主神经的影响 ,并探讨其对AMI后心律失常的防治作用。 17条AMI模型狗被随机分为对照组、倍他乐克组和洛汀新组。测量AMI前、AMI后 1h和 4个月的心率变异(HRV) ,并在AMI后 4个月采用逐级右室快速起搏方法诱发心室颤动。时域分析指标以RR间期的标准差 (SDNN)和相邻RR间期差值平方和的均方根 (rMSSD)表示 ,频域分析包括高频 (HF 0 .15～ 0 .40Hz)、低频 (LF 0 .0 4～ 0 .15Hz)和极低频 (VLF 0 .0 0 33～ 0 .0 4Hz)。结果 :对照组中 ,SDNN、rMSSD、LF/HF在AMI后 4个月轻度恢复 ;倍他乐克组和洛汀新组在AMI后 4个月明显改善 ,与AMI后 1个月相比较 ,SDNN(188± 5 4vs 140± 44ms和 172± 32vs 12 7± 2 9ms)、rMSSD(32± 10vs 2 2± 5ms和 34± 8vs 2 3± 6ms)、HF(0 .48± 0 .0 2vs 0 .2 7± 0 .0 2ms2 和 0 .49± 0 .0 1vs 0 .2 7± 0 .0 1ms2 )、LF/HF(0 .6 5± 0 .0 3vs 1.74± 0 .15ms2 和 0 .6 7± 0 .0 3vs 1.6 9± 0 .11ms2 )差异有显著性 ,P均 <0 .0 5或 0 .0 1。三个实验组的心室颤动诱发率分别为 83% ,2 0 % ,3%。结论 :β受体阻断剂和血管紧张素转换酶抑制剂能改善AMI后的自主神经调控 ,防治AMI后室性心律失常的发生。     

Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

Objectives The long-term benefit of late reperfusion of infarct-related artery (IRA) after acute myocardial infarction (AMI) is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography (LDSE) can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixty-nine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments (57%) were viable during LDSE. 26 patients (38%) with viability and 43 (62%) without. In viable group, left ventricular ejection fraction (LVEF) was increased (P < 0.05), and left ventricular end systolic volume index (LVESVI) and wall motion score (WMS) were decreased (P < 0.05 and P < 0.01) significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased (P < 0.01), and LVESVI and left ventricular end diastolic volume index (LVEDVI) were increased (P<0.05) significantly after 6 months, and the WMS did not changed (P > 0.05). LVEF increased (P< 0.05) and WMS decreased (P < 0.05) on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.     

小剂量倍他乐克对老年急性心肌梗死后心室晚电位干预的研究

目的　探讨小剂量倍他乐克对老年急性心肌梗死 (AMI)后心室晚电位 (VLP)长期干预的作用。方法　将 1 68例老年 AMI后 VLP阳性患者随机分为两组 ,86例干预组患者服倍他乐克 6.2 5～ 2 .5 mg/次 ,2次 /d,82例对照组常规服消心痛。结果　小剂量倍他乐克干预后能使 VLP转阴 (74/86) ,使 SA- ECG的 TD- QRS、LAS较治疗前缩短 ,RMS增加 (P<0 .0 1 ) ,并有效控制室性心律失常发生。结论　小剂量倍他乐克长期干预能使老年 AMI患者 VLP转阴 ,同时又避免大剂量快速用药所致副作用。老年 AMI患者出现 VL P阳性如无明显β-阻滞剂禁忌 ,应首选小剂量倍他乐克长期治疗。     

倍他乐克治疗老年慢性心力衰竭的临床研究

目的 观察倍他乐克治疗老年慢性心力衰竭（CHF）的疗效.方法 选择76例老年CHF患者随机分成对照组（B组）37例,给予常规抗心衰药物治疗;倍他乐克组（A组）39例,在对照组治疗基础上加用倍他乐克,治疗观察随访6个月,观察并比较两组患者的临床疗效.结果 A组患者的血压、心率、LVEDD、LVESD均明显下降（P＜0.05）,LVEF值明显提高（P＜0.05）.对照组LVEDD明显下降,LVEDD、LVESD、LVEF与A组比较差异有显著性意义（P＜0.05）.A、B两组患者临床疗效间差异有非常显著性意义（P＜0.05）.结论 老年CHF患者可长期安全有效地应用倍他乐克治疗,并能改善心功能,提高生活质量,降低远期死亡率,延长寿命.     

急性心肌梗死早期使用倍他乐克预防心律失常的疗效分析

目的探讨急性心梗早期使用倍他乐克减少室性或室上性心律失常的作用。方法将232例急性心梗病例随机分为2组：A组（治疗组）在常规治疗基础上口服倍他乐克25-50mg／次，一日2次；B组（对照组）仅予常规治疗。比较两组疗效。结果在治疗后的第3个月和第6个月时，倍他乐克组患者发生室性、室上性心律失常及心律失常性死亡的患者明显减少；与对照组相比差异具有统计学意义（P〈0．05）。结论急性心梗早期使用倍他乐克能减少室性和室上性心律失常的发作。     

Effects of Late Reperfusion on Left Ventricular Function and Its Relationship With Viable Myocardium After Acute Myocardial Infarction in Patients With or Without Diabetes

Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）     

国产卡托普利联合倍他乐克治疗原发性高血压疗效观察

目的探讨治疗高血压经济、有效的药物。方法选择90例原发性高血压患者分2组进行达标血压治疗4周。结果2组药物治疗4周后,平均收缩压、舒张压、心率均较服药前明显降低,差异均有非常显著性意义(P<0.01)。治疗组治疗后与对照组治疗后比较收缩压、舒张压、心率差异均无显著性意义(P>0.05),2组疗效间比较差异无显著性意义(χ2=0.05,P>0.05)。结论2组药物治疗高血压疗效无差异,国产卡托普利联合倍他乐克治疗原发性高血压,可以减少治疗成本,改善顺从性。     

急性心肌梗死病人肌钙蛋白I含量与梗死面积和部位的关系

目的探讨急性心肌梗死(AMI)病人的肌钙蛋白I(cTnI)的含量与梗死面积和部位的关系, 以评估AMI的病情程度及预后.方法健康对照组60例,于09:00空腹抽静脉血3 ml,分离血清.AMI组58例,于胸痛发作后3 h、6 h、9 h、12 h时抽静脉血3 ml,分离血清.cTnI 采用化学发光免疫分析法(CLIA)定量检测.肌酸激酶同工酶(CK-MB)采用连续监测法定量检测.结果急性广泛前壁梗死病人的cTnI含量与对照组及急性前壁、间壁梗死、急性下壁、侧壁梗死组比较有统计学意义(P＜0.01),与急性非Q波性梗死组比较无统计学意义(P>0.05).cTnI含量与CK-MB有良好的相关性.结论用CK-MB计算梗死面积已得到病理和临床证实.cTnI含量与CK-MB有良好的相关性,说明cTnI含量越高AMI病人的梗死面积越大.实验结果表明,cTnI含量与AMI病人的梗死面积呈正相关,与梗死部位无明显相关性.