琥珀酸美托洛尔缓释片对慢性心房颤动伴慢性充血性心力衰竭患者心室率及心功能的影响

目的观察琥珀酸美托洛尔缓释片对慢性心房颤动（AF）伴慢性充血性心力衰竭（CHF）患者心室率及心功能的影响。方法慢性AF合并CHF患者共69例，随机分为治疗组（35例）和对照组（34例），两组均常规使用地高辛、利尿剂、血管紧张素转换酶抑制剂（ACEI）或血管紧张索Ⅱ受体拮抗剂（ARB）、抗凝剂。治疗组在常规治疗的基础上给与琥珀酸美托洛尔缓释片。治疗6个月，观察两组治疗前后静息心室率、运动后心室率、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）及6min步行试验。观察治疗后6个月时的临床症状变化。结果①两组患者的静息心室率治疗后比治疗前均明显降低（P〈0．01）；运动后心室率治疗组治疗后比治疗前明显减低（P〈0．01），对照组治疗前后变化不显著（P〉0．05），治疗后运动后心室率治疗组比对照组明显减低（P〈0．01）；②治疗6个月后两组左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）、左室射血分数（LVEF）、6min步行试验都有明显改善（P〈0．01～0．05），但治疗组明显优于对照组，差异有统计学意义（P〈0．05）；③治疗组临床症状改善，总有效率为93．8％，明显高于对照组的77．4％（P〈0．05）。结论在使用强心、利尿、ACEI或ARB基础上，琥珀酸美托洛尔缓释片能有效控制慢性AF伴CHF患者心室率，显著改善心功能，改善心室重塑。

Influenc of Metoprolol Succinate Sustained-release Tablets therapy on ventricular rate and heart function of patients with chronic atrial fibrillation and chronic heart failure

Objective To study the influenc of metoprolol succinate sustained-release tablets therapy on ventricular rate and heart function of patients with chronic atrial fibrillation(CHF)and chronic heart failure(HF).Methods A total of 69 patients with chronic atrial fibrillation and chronic heart failure were randomly divided into treatment group(35 cases)and control group(34 cases).The general therapy included digoxin,diuretics,angiotensin-converting enzyme inhibitors(ACEI)or angiotensin-Ⅱ-receptor antagonists(ARB)and anticoagulants for a 6-momth follow-up period.The patients of treatment group was treated with metoprolol succinate sustained-release tablets above the base of the general therapy.The ventricular rate at rest and the ventricular rate after 6-minute walk,left ventricular end diastolic dimension(LVEDD),left ventricular end systolic dimension(LVESD),left ventricular ejection fraction(LVEF)and the distance of 6-minute walk were examined before and 6 months after therapy.After 6 months,to compare the changes of clinical manifestations.Results ①The ventricular rate at rest decreased significantly in both two groups(P＜0.01),the ventricular rate after 6-minute walk decreased significantly in treatment group 6 month after treatment(P＜0.01),but there was no significant difference betwen before and after treatment in control group on the ventricular rate after 6-minute walk(P＞0.05),and the ventricular rate after 6-minute walk was decreased more in tretment group than that in control group(P＜0.01).②The LVEF,LVEDD,LVESD and the distance of 6-minute walk in both groups had significant improvement as compared with before treatment(P＜0.01～0.05),with the treatment group showing a better improvement than in control group(P＜0.05).③The total responsive rate in the treatment group(93.8%)was significantly higher than in control group(77.4%)(P＜0.05).Conclusion Based on the medication of digitalis,diuretics and ACEI or ARB,metoprolol succinate sustained-release tablets therapy can effectively control ventricular rate,significantly improve heart function and also reverse left ventricular in patients with chronic atrial fibrillation and chronic heart failure.