β受体阻滞剂对军事训练后心血管病高危患者应激反应与心功能的影响

目的 观察β受体阻滞剂对心血管病高危患者军事训练后应激反应与心脏功能的影响.方法 采用问卷调查、体格检查和12导联心电图综合调查的方法,纳入某集团军心血管病高危人群同时心率≥60次/min者80例,随机分为高危给药组（n=40）和高危对照组（n=40）,另选取低危人群中心率≥60次/min且年龄相当者40例作为低危对照组.高危给药组在运动前5天起持续给予琥珀酸美托洛尔（23.75 mg,qd）,高危对照组和低危对照组予相同剂量安慰剂.比较三组5千米跑步运动前后心率、血压变化,以及肾上腺素（EPI）、超敏C反应蛋白（hs-CRP）、热休克蛋白70（HSP70）和脑钠肽（BNP）浓度的变化.结果 运动前三组心率血压乘积和各项生化指标无明显差异,运动后低危对照组、高危给药组和高危对照组心率血压乘积、EPI、hs-CRP、HSP70、BNP浓度均逐渐升高,两两之间都存在统计学差异（P＜0.05）.结论 心血管病高危患者军事训练后的应激反应及心脏功能改变较低危者明显,提前应用β受体阻滞剂可以改善这一趋势,有助于减少急性心血管病事件甚至心源性猝死的发生.

Influences of beta-blocker on stress response and heart function in patients with high risk of cardiovascular diseases after military training

Objective To observe the influences of beta-blocker on stress response and heart function in the patients with high risk of cardiovascular diseases after military training. Methods A comprehensive method was used including questionnaire survey, physical examination and 12-lead electrocardiogram. The population with cardiovascular high-risk [heart rate （HR）≥ 60/min, n=80] were randomly divided into high-risk drug group and high-risk control group （each n=40）, at the same time other low-risk population （HR≥ 60/min, n=40） with the same age was chosen as low-risk control group. The high-risk drug group was given metoprolol （23.75 mg, qd） for 5 days before exercise, and high-risk control group and low-risk control group, placebo in equal dose. The changes of HR, blood pressure （BP）, epinephrine （EPI）, high-sensitivity C-reactive protein （hs-CRP）, heat shock protein 70 （HSP70） and brain natriuretic peptide （BNP） were compared among three groups before and after running for 5000 m. Results There was no significant difference in rate-pressure product and biological indexes among three groups before exercise. After the exercise, rate-pressure product, EPI, hs-CRP, HSP70 and BNP increased gradually and there was statistical difference in the pairwise comparison among three groups （P〈0.05）. Conclusion The stress response and changes of cardiac function are more significant in patients with high risk of cardiovascular diseases compared with low-risk population after military training. The administration of beta-blocker in advance can inhibit this tendency and reduce the incidence of acute cardiovascular events even cardiogenic sudden death.