急性心肌梗死患者心率变异性的改变及β受体阻滞剂的干预作用

目的 探讨急性心肌梗死(AMI)患者心室肌心率变异性(HRV)的改变以及应用β受体阻滞剂对AMI患者HRV的影响.方法 64例AMI患者随机分为对照组及阿替洛尔组,每组32例.两组患者用药前及用药后2 w记录24 h 动态心电图,观察患者HRV指标变化.结果 两组治疗后HRV各参数较治疗前均显著改善(P＜0.01).治疗后阿替洛尔组较对照组改善更为显著(P＜0.01).结论 AMI患者应用β受体阻滞剂可显著改善HRV,减少心律失常的发生率,降低病死率,具有普遍适用性.     

静脉及口服美托洛尔对急性心肌梗死住院患者血压与心率的影响(中国心脏研究-Ⅱβ阻滞剂预试验报告)

目的评估β阻滞剂美托洛尔对急性心肌梗死(AMI)住院患者血压及心率的影响.方法入选发病24 h内可疑AMI的住院患者,且无研究药物明确禁忌证的.将入选对象随机分为β阻滞剂美托洛尔治疗组或相应安慰剂组.首先静脉注射美托洛尔或安慰剂5 mg,间隔2～3 min后,再注射5 mg,注射3次共15 mg然后美托洛尔/安慰剂口服第1天为50 mg,4次/d;第3天起为200mg,1次/d.疗程最长4周或出院.主要研究指标是血压、心率、其他不良反应、病死率及其他并发症.结果 1999-11-2000-05,10家大中医院完成预试验研究236例,其中随机分到美托洛尔治疗组120例,安慰剂对照组116例.治疗前两组患者基础临床特征相似.当天进行静脉注射的美托洛尔与安慰剂组分别为100%与99.2%,完成3支静脉注射的为87.9%与95.8%;住院期提前停用的为24.4%与13.6%.治疗后,美托洛尔组低血压、心动过缓发生率均明显高于安慰剂组(P≤0.05～0.01);两组总病死率(7.8%vs 8.4%)相似(P=0.86),其他并发症也无明显差异.美托洛尔静注及口服后治疗组心率明显均低于对照组(P＜0.01),血压略低于安慰剂组.结论美托洛尔早期治疗AMI住院患者低血压及心动过缓发生率较高.     

心梗后QT离散度的意义及美托洛尔的影响

目的观察心肌梗死QT离散度(QTd)对合并室速、室颤(vt、vf)及近远期预后的临床意义及美托洛尔对心梗患者QTd及心脏事件(再发心梗、心衰、室速室颤猝死)发生的影响.方法106例急性心梗患者(AMI)和100例健康人对照作进行QTd测定,对AMI存活患者中的50例给予美托洛尔治疗,并以未用美托洛尔的常规治疗者作为对照,观察QTd变化及心脏事件发生率,随访期最多5年(平均4.40士1.45年).结果(1)AMI患者QTd显著高于健康人(P＜0.001);大面积心梗组QTd显著高于单一部位心梗组(P＜0.05);(2)AMI合并vt、vf组QTd显著高于不合并vt、vf组(P＜0.001),凡QTd≥80ms者其vf发生率明显高于小于80ms者(P＜0.01);(3)心梗患者远期发生猝死者其AMI后4周时的QTd都≥60ms,且均值显著高于存活者(P＜0.001);(4)经美托洛尔治疗后QTd明显缩短,心脏事件发生率明显低于不用美托洛尔(常规)组(P＜0.01).结论QTd对预测AMI预后及vt、vf发生率有一定价值,4周后QTd仍增高可能与远期猝死率有关;AMI后出院患者用美托洛尔治疗可使QTd正常化加快,有利于防止和减低心脏事件的发生,降低心梗患者的远期猝死率.     

高龄慢性阻塞性肺疾病患者长期雾化吸入布地奈德的疗效及安全性评估

目的 观察高龄慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者雾化吸入布地奈德混悬液的临床疗效及安全性评估.方法 25例高龄COPD稳定期患者随机分为两组,分别给予布地奈德1mg bid,2 mg bid雾化吸入1年.15例正常高龄老人为对照组.结果 雾化吸入布地奈德2mg bid明显改善COPD患者PaCO2(P＜0.01)、FEV1 (P＜0.05).治疗6m后两组CAT评分均较治疗前明显改善(P＜ 0.05,P＜0.01);较高剂量组治疗12 m后CAT评分较治疗6m后有进一步改善(P＜0.05),治疗6m后及12 m后的CAT改善率均优于较低剂量组(P＜0.05,P＜ 0.01).两组患者治疗期内慢性阻塞性肺疾病急性加重的发生率无明显差异.治疗组与正常对照组相比,糖代谢及血尿骨代谢均无明显影响.治疗期间两组患者肺炎的发生率无明显差异.结论 雾化吸入布地奈德1年可改善中重度COPD高龄患者肺功能和临床症状,未对糖代谢和骨代谢产生不良影响.较高剂量雾化吸入布地奈德1年未增加COPD患者的肺炎发生率.     

静脉及口服美托洛尔对急性心肌梗死住院患者血压与心率的影响（中国心脏研究-Ⅱβ阻滞剂预试验报告）

目的评估β阻滞剂美托洛尔对急性心肌梗死(AMI)住院患者血压及心率的影响。方法入选发病24 h内可疑AMI的住院患者,且无研究药物明确禁忌证的。将入选对象随机分为β阻滞剂美托洛尔治疗组或相应安慰剂组。首先静脉注射美托洛尔或安慰剂5 mg,间隔2~3 min后,再注射5 mg,注射3次共15 mg;然后美托洛尔/安慰剂口服第1天为50 mg,4次/d;第3天起为200 mg,1次/d。疗程最长4周或出院。主要研究指标是血压、心率、其他不良反应、病死率及其他并发症。结果1999-11-2000-05,10家大中医院完成预试验研究236例,其中随机分到美托洛尔治疗组120例,安慰剂对照组116例。治疗前两组患者基础临床特征相似。当天进行静脉注射的美托洛尔与安慰剂组分别为100%与99.2%,完成3支静脉注射的为87.9%与95.8%;住院期提前停用的为24.4%与13.6%。治疗后,美托洛尔组低血压、心动过缓发生率均明显高于安慰剂组(P≤0.05~0.01);两组总病死率(7.8%vs 8.4%)相似(P=0.86),其他并发症也无明显差异。美托洛尔静注及口服后治疗组心率明显均低于对照组(P<0.01),血压略低于安慰剂组。结论美托洛尔早期治疗AMI住院患者低血压及心动过缓发生率较高。     

心率变异对原发性高血压患者预后的影响

目的探讨心率变异(HRV)对原发性高血压患者预后的影响。方法选择2004年8月—2006年4月来我院就诊的原发性高血压患者130例,随访3年。所有患者随访前后行动态心电图(Holter)、动态血压监测和颈动脉内膜中膜厚度检测检查。按照HRV的全部R-R间期的标准差(SDNN)≥100ms和100ms,分为正常组和异常组,异常组随机分为两组,其中一组接受美托洛尔治疗,称为美托洛尔组,而另一组仍称为异常组。3组患者均给予常规药物治疗。观察3年心脑血管事件发生率。结果用药3年后,美托洛尔组SNDD较异常组好转(P0.01);MBPS发生率也明显减少(P0.05),但仍高于正常组(P0.01);异常组的IMT较正常组和美托洛尔组明显增厚(P0.05);HR则美托洛尔组明显减慢(P0.05)。异常组心脑血管事件发生明显高于正常组(P0.05)和美托洛尔组(P0.05),而正常组和美托洛尔组之间无明显差别。结论 HRV异常的原发性高血压患者可能预示动脉硬化进展加快,HRV成为判断原发性高血压患者预后的指标之一。美托洛尔可干预HRV的异常,改善原发性高血压患者的预后。     

银丹心脑通软胶囊对急性心肌梗死患者血清VEGF的影响

目的 观察银丹心脑通软胶囊对急性心肌梗死(AMI)患者血清血管内皮生长因子(VEGF)的影响,探讨银丹心脑通软胶囊治疗AMI的可能机制.方法 60例AMI患者随机分为银丹心脑通软胶囊治疗组(30例)和常规治疗对照组(30例),30例疑似心绞痛而冠脉造影正常者为正常对照组.分别检测AMI患者起病后第1天、第4天、第7天、第14天和第28天时的血清VEGF浓度.对照组随机采血一次检测.结果 入院后第1天AMI患者血清VEGF浓度开始升高,治疗组第4天VEGF浓度达高峰,高于对照组(P＜0.01),第7天血清VEGF浓度明显低于对照组(P＜0.01).治疗组第14天VEGF浓度仍呈降低趋势,低于对照组,两组比较有统计学意义.第28天两组比较差异无统计学意义(P＞0.05).结论 银丹心脑通软胶囊治疗能影响AMI患者血清VEGF水平,推测其通过促进侧支循环的建立参与保护缺血的心肌.     

小剂量长疗程尿激酶治疗不稳定性心绞痛的临床研究

目的探讨应用小剂量长疗程尿激酶治疗不稳定性心绞痛的疗效.方法将符合入选标准的228例不稳定性心绞痛病人分为观察组118例,在常规治疗的基础上,加尿激酶20万～30万IU/d静脉滴注,对照组110例,仅采用常规治疗方法,疗程均为10天.分别于治疗第5天和第10天统计心绞痛缓解程度、出血并发症以及心脏事件[急性心肌梗死(AMI)或死亡]等的发生率.结果治疗第5天,心绞痛缓解显效率观察组明显高于对照组(79.6%对68.2%,P＜0.05),加拿大心脏病学会(CCS)分级观察组明显低于对照组(P＜0.05),而轻度粘膜出血、急性心肌梗死(AMI)及死亡事件的发生率两组间差异无显著性;治疗第10天,两组间心绞痛缓解显效率及CCS分级仍然存在差异(P均＜0.05),而轻度粘膜出血、AMI及死亡事件的发生率两组间差异仍无显著性意义;两组均未发生脑出血事件.结论在常规抗心绞痛、抗血小板、抗凝血酶治疗的基础上,联合小剂量长疗程尿激酶的综合方案治疗不稳定性心绞痛,其心绞痛缓解有效率高于常规方案,而出血、AMI等并发症并无明显增加,尤其对不能或不愿接受介入治疗的病人值得应用.     

美托洛尔对舒张功能不良性心衰患者心率变异性的影响

目的探讨舒张功能不良性心衰患者应用美托洛尔后心脏自主神经功能的变化。方法对照组常规抗心衰治疗,治疗组在常规抗心衰治疗的基础上加服美托洛尔,从12.5mg/d开始,缓慢增加剂量至25～50mg/d,治疗前和治疗3个月后分别进行心率变异性(HRV)分析。结果与对照组比较,治疗组治疗3个月后HRV指标SDNN、SDANN、rMSSD、PNN50均明显提高(P<0.01),且心功能改善明显优于对照组(P<0.05)。结论在常规治疗的基础上,加用美托洛尔治疗舒张功能不良性心衰,可改善心脏自主神经调节功能,可提高HRV,增强疗效。     

胺碘酮、门冬氨酸钾镁联合美托洛尔治疗急性心肌梗死并发室性心律失常的疗效观察

目的探讨胺碘酮、门冬氨酸钾镁联合美托洛尔治疗急性心肌梗死(AMI)并发室性心律失常的临床疗效。方法采用随机数字表法将84例受试者分为观察组(42例,给予胺碘酮、门冬氨酸钾镁联合美托洛尔治疗)和对照组(42例,给予美托洛尔治疗),治疗1个疗程后,观察两组患者临床疗效及不良事件发生情况。结果观察组治疗总有效率(95.24%)显著高于对照组(73.81%),不良事件发生率(9.52%)显著低于对照组(30.95%),差异对比均有显著性(P0.01)。结论对于AMI并发室性心律失常患者,胺碘酮、门冬氨酸钾镁与美托洛尔联合给药是一种疗效确切的有效治疗方案,有助于降低患者死亡率。     

美托洛尔治疗急性心肌梗死的疗效及安全性

目的探讨静注及口服美托洛尔对急性心肌梗死（AM I）患者安全性及临床疗效。方法365例发病在24 h内的AM I患者随机分成美托洛尔治疗组（n=182例）和对照组（n=183例）,在常规治疗的基础上,治疗组给予静注及口服美托洛尔,对照组给予安慰剂,观察两组患者临床特征,住院期间治疗前后平均血压、心率及主要心脏不良事件发生情况。结果美托洛尔组患者吸烟和饮酒患者的比例显著高于对照组（P<0.05）,其他一般临床特征相同;美托洛尔组患者用药前后血压及心率下降幅度与对照组相比均存在显著性差异（P<0.05）;美托洛尔组患者发生梗死后心绞痛和室性心律失常的比率显著少于对照组（P<0.05）,发生再梗、脑梗、心源性休克和住院期间死亡的比率,与对照组相比无统计学差异。结论早期静注及口服美托洛尔,可明显降低AM I患者室性心律失常和梗死后心绞痛发生率,但并不降低住院期间总的病死率。     

Metoprolol in acute myocardial infarction reduces ventricular arrhythmias both in the early stage and after the acute event

Fifty three of the 5778 patients included in the MIAMI (Metoprolol in Acute Myocardial Infarction) trial were investigated with long-term ECG recordings in order to evaluate the effect of acute beta-blockade on premature ventricular complexes in and after acute myocardial infarction. Twenty five patients were given placebo and 28 metoprolol in a double-blind randomized fashion for 15 days. After this period the patients were put on open beta-blockade without breaking individual study codes. The mean number of premature ventricular complexes during the inclusion day (day 0) was the same in the two groups. The median numbers were also similar in the two groups: 190 and 154 in the placebo and metoprolol groups, respectively. Metoprolol significantly reduced the median number of premature ventricular complexes in the randomized period. The median numbers on days 1, 2 and 15 were 146, 101, 84 in the placebo group and 73, 59 and 10 in the metoprolol group, respectively (P less than 0.05). Also during the further follow-up, when investigated 1, 3 and 6 months after the infarction, the median number of premature ventricular complexes was lower in the metoprolol group (74, 257, 142 in the placebo group and 7, 5 and 11 in the metoprolol group, P less than 0.05). This indicates that metoprolol treatment in the acute phase of myocardial infarction reduces ventricular arrhythmias both in the early stage and also after the acute event.     

胺碘酮联合酒石酸美托洛尔治疗急性心肌梗死并发快速心律失常临床研究

目的探究胺碘酮联合酒石酸美托洛尔治疗急性心肌梗死并发快速心律失常的临床效果。 方法选择2016年2月至2017年6月胶州市人民医院收治的104例急性心肌梗死并发快速心律失常患者,按随机数表法分为对照组(52例)和试验组(52例)。在常规治疗基础上,对照组接受胺碘酮治疗,试验组接受胺碘酮联合酒石酸美托洛尔治疗,均治疗1个月。对比两组治疗效果、不良反应发生情况及治疗前、治疗1个月后心功能[左心室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)]水平。 结果试验组治疗1个月后总有效率90.38%较对照组69.23%高(P<0.05)。两组治疗1个月后LVEF水平均较治疗前增高,且试验组较对照组高(P<0.05)。两组治疗1个月后LVESD及LVEDD水平较治疗前降低,且试验组较对照组低(P<0.05)。试验组不良反应发生率13.46%与对照组9.62%对比,差异无统计学意义(P>0.05)。 结论对急性心肌梗死并发快速心律失常患者采取胺碘酮联合酒石酸美托洛尔治疗效果显著,可改善患者心功能,且安全性良好。     

Different Action of Beta‐blockers on Daytime and Nighttime Heart Rate Variability

Background: Beta‐blockers in patients surviving acute myocardial infarction (AMI) and in those with dilated cardiomyopathy have proven to be of beneficial effect, particularly for the sudden cardiac death rate. They are also used to control various forms of arrhythmias because of the strong correlation between cardiac arrhythmias and adrenergic reaction. Heart rate variability (HRV) variables provide valuable information related to the autonornic nervous system function. The present prospective study was undertaken to investigate the effects of beta‐blockers on 24‐hour HRV. Methods: We studied 60 patients, aged 39 to 76 years (mean 56 ± 15). Forty of the patients had survived a myocardial infarction 12 to 24 months previously (group I). Twenty patients did not have apparent cardiac heart disease (group II). Twenty‐four‐hour monitoring was performed at baseline and after 8 to 10 days of atenolol (100 mg/day, n = 35) or metoprolol (100 to 150 mg/day, n = 25) (BB). Measures of HRV in the time and frequency domains were calculated and printed for the the entire 24 hours and from 09:00 to 21:00 (daytime) and 23:00 to 6:00 (nighttime). The 24‐hour analysis of HRV shows an improvement over control values in indices of parasympathetic tone, but the results were statistically significant only for high frequency power (HF) in groups I (P < 0.01) and II (P < 0.05). A significant decrease of the coefficient of variance was noted in group II (P < 0.05). The analysis during the day and the night revealed a predominant action of beta‐blockers during the night with a high frequency increase in both groups from 64.5 ± 45 to 161 ± 111 ms² in group I (P < 0.001) and from 99 ± 89 to 268 ± 348 ms2 in group II (P < 0.02). In group II, the daily high frequency power did not vary after beta‐blockers. The decrease of the coefficient of variance in group II disappeared in the daily and nightly analysis Conclusions: Beta‐blockers enhance the HRV indexes reflecting the parasympathetic activity especially during the night in patients with and without ischemic heart disease. Although an indirect effect of beta‐blockers on respiration cannot be excluded, this effect could explain one of the beneficial effects of beta‐blockers on general survival in patients with and without myocardial infarction.     

Effects of glucose-insulin-potassium solution added to reperfusion treatment in acute myocardial infarction.

OBJECTIVE: Reperfusion treatment modalities used in the routine treatment protocols of acute myocardial infarction (AMI) were found to be ineffective in establishing the nutritional cellular reperfusion in the microvascular environment even they succeed to open the infarct related artery. Glucose-insulin-potassium (GIK) solution, which is presumed to stimulate the glycolytic pathway, is experimentally proven to be the most efficacious substrate for the preservation of energy production and therefore the myocardial viability, in the setting of acute ischemia. METHODS: We compared, 54 patients who suffered AMI and received GIK solution (300 g glucose+50 IU crystallized insulin+80 mEq potassium chloride in one liter solution) in addition to conventional treatment (GIK group) with 27 patients who were traditionally treated (control group) for in-hospital and early-term (1 month) cardiac morbidity. We also compared the two groups in terms of heart rate variability (HRV). RESULTS: Eight patients in the control group developed new-onset symptomatic congestive heart failure whereas only 5 patients in GIK group were found to have such a cardiac morbidity (p=0.01). Reduced HRV (<50 ms) was found in 3 patients of control group whereas no patient in GIK group had abnormal HRV (p=0.01). CONCLUSION: The GIK solution decreased the incidence of new-onset symptomatic congestive heart failure and low HRV after myocardial infarction. Larger multicenter trials need to resolve the questions on the efficiency of metabolic intervention with GIK solution in acute myocardial infarction.     

倍他乐克在糖尿病急性心肌梗死患者中的疗效

目的探讨糖尿病急性心肌梗死患者早期应用倍他乐克的疗效。方法选择糖尿病急性心肌梗死患者88例,随机分为两组,常规治疗组（n=44）给予静脉溶栓、阿司匹林、硝酸脂类等药物治疗,倍他乐克组（n=44）在常规治疗基础上加用倍他乐克,比较两组一个月内全因死亡率、恶性心律失常和心肌梗死后心绞痛发生率、以及血糖和血脂等变化等情况。结果经过治疗后,倍他乐克组各种原因死亡率、恶性心律失常发生、心肌梗死后心绞痛发生率均低于常规治疗组,两组间差异有统计学意义（P均〈0.05）。两组治疗后血糖水平均有下降,与治疗前比较,差异均有显著统计学意义（P均〈0.01）;常规治疗组治疗后血糖水平低于倍他乐克组,两组间差别有显著统计学意义（P〈0.01）;两组治疗后总胆固醇及甘油三脂水平与治疗前差异均无统计学意义,两组治疗后血脂的差异也无统计学意义（P均〉0.05）。结论糖尿病急性心肌梗死患者早期应用倍他乐克降低死亡率、恶性心律失常及心肌梗死后心绞痛发生率,而对血糖、血脂影响较小。     

Long-term treatment with metoprolol after myocardial infarction: effect on 3 year mortality and morbidity

The effects of metoprolol treatment in patients surviving acute myocardial infarction have been investigated in a double-blind randomized study. The patients were stratified according to age, infarct size and type of ventricular arrhythmias before administration of metoprolol, 100 mg twice daily (n = 154), or placebo (n = 147). All patients were followed up for 36 months. There were 31 (29 cardiac) and 25 (20 cardiac) deaths in the placebo and metoprolol groups, respectively. Subgroup analyses showed a significant reduction of cardiac death in patients with a large infarct (32.1% with placebo versus 12.5% with metoprolol, p less than 0.05) as a result of active treatment. Sudden death rates were 14.7% in the placebo versus 5.8% in the metoprolol group (p less than 0.05). The incidence of nonfatal reinfarction was 21.1% in the placebo versus 11.7% in the metoprolol group (p less than 0.05). The reduction in nonfatal reinfarction was similar in all pretreatment risk strata. The difference between the two groups in cumulative number of cardiac deaths and patients experiencing nonfatal reinfarction increased throughout the study. Furthermore, cerebrovascular events (p less than 0.05) and coronary bypass surgery (p = 0.058) were more frequent in the placebo group. In conclusion, after 36 months of metoprolol treatment after myocardial infarction, there was a significant reduction of nonfatal reinfarction and sudden death in all patients and a reduction of cardiac death in those with a large infarct.     

不同剂量阿托伐他汀对急性心肌梗死并高尿酸血症患者的疗效

目的：探讨不同剂量阿托伐他汀对急性心肌梗死并高尿酸血症患者经皮冠状动脉介入治疗（PCI）术后血脂、血尿酸（SUA）、高敏C反应蛋白（hsCRP）、心脏不良事件的影响及安全性。方法：62例接受急诊PCI的急性ST段抬高心肌梗死并高尿酸血症患者被随机分为：A组（32例）、B组（30例）。两组患者术前均给予阿托伐他汀钙80mg顿服,A组术后给予阿托伐他汀钙40mg 1次/d口服,1个月后转为20mg 1次/d长期口服。B组术后给予20mg 1次/日长期口服。于术前、术后72h、1周、1月测定SUA、hsCRP,术前、术后1月测定血脂、肝功、肌酸激酶、随访心脏不良事件。结果：入院时两组SUA、hsCRP、血脂之间差异无显著性（P〉0.05）。两组术后72h、1周、1月SUA水平逐渐下降,A组较B组降低更明显[1月后：（306.88±46.03）mmol/L比（365.90±35.47）mmol/L,P〈0.05]。两组术后72hhsCRP水平均较入院时明显升高（P〈0.05）,术后1周、1月逐渐降低,A组较B组降低更明显[1月后：（2.10±1.29）mg/L比（3.55±0.63）mg/L,P〈0.05]。两组术后血脂水平无明显差异（P〉0.05）。A组心脏不良事件发生率明显低于B组（0比6.6%,P〈0.05）。两组无病例出现严重肝功损害和肌痛等现象。结论：大剂量阿托伐他汀能明显降低血尿酸、高敏C反应蛋白水平、降低炎性反应,改善内皮功能,减少心脏不良事件的发生,安全性好。     

西洋参茎叶总皂苷对急性心肌梗死大鼠心肌能量代谢的影响

目的探讨西洋参茎叶总皂苷是否能改善缺血心肌细胞的能量代谢。方法选用急性心肌梗死模型大鼠,随机分为心悦胶囊大、中、小剂量组,倍他乐克组,模型组,同时设假手术及正常组(每组各8只)。药物治疗组于术后第2天开始灌胃给药,每日1次,术后第15天取心肌组织制成匀桨,采用高效液相色谱(HPLC)法测定心肌组织中ATP、ADP、AMP的含量,并计算总腺苷酸(TAN)含量及能荷(EC)值。结果心悦胶囊治疗组ATP的含量及EC水平均高于模型组,其中心悦胶囊大剂量组ATP的含量及心悦胶囊大、中、小剂量组的EC水平升高显著(P<0.05)。结论西洋参茎叶总皂苷能提高缺血心肌组织中ATP含量及EC的贮备水平。     

美托洛尔注射液早期治疗非ST段抬高急性心肌梗死患者血清氨基端脑钠肽前体水平研究

目的:观察美托洛尔注射液早期治疗非ST段抬高急性心肌梗死患者血清氨基端脑钠肽前体(NT-ProBNP)水平变化.方法:将69例非ST段抬高急性心肌梗死患者(KiUip分级Ⅰ～Ⅱ级)随机分成两组,治疗组34例为症状出现24 h内予静脉注射美托洛尔,对照组35例为常规治疗.两组均在入选6 h内、第7天和第28天检测血清NT-ProBNP浓度以及监测第1天、第28天左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)、室上性和室性心律失常计数.结果:血清NT-ProBNP浓度变化:治疗组第7天、第28天血清NT-ProBNP浓度分别为(155.43±30.56)pg/ml、(105.43±30.56)pg/ml与对照组第7天、第28天(289.9±42.3)pg/ml、(209.9±42.3)pg/nd比较明显下降,差异有统计学意义(P＜0.05);且治疗组第7天血清NT-ProBNP浓度与最初6 h血清NT-ProBNP浓度(320.2±50.5)pg/ml相比也明显下降,差异有统计学意义(P＜0.05).69例患者28天内死亡4例患者与非死亡65例患者平均血清NT-ProBNP水平分别为[(620.8±160.5)pg/ml、(187.8±89.6)pg/ml,两者比较差异有统计学意义(P＜0.05).心脏超声变化:治疗组第1天和第28天的前后差值与对照组第1天和第28天的前后差值比较,左心室舒张末期内径、左心室收缩末期内径显著减少,差异均有统计学意义(P＜0.05).动态心电图监护:治疗组第1天和第28天的前后差值与对照组第1天和第28天的前后差值比较,室上性心律失常计数、室性心律失常计数显著升高,差异均有统计学意义(P＜0.05).结论:非ST段抬高急性心肌梗死患者早期应用美托洛尔注射液治疗是安全的,并能显著降低血清NT-ProBNP水平,降低心律失常发生,改善心室重塑.死亡患者血清NT-ProBNP浓度显著升高.