静脉注射艾司洛尔治疗急性心肌梗死并发急性心力衰竭的疗效及安全性

目的探讨静脉注射艾司洛尔治疗急性心肌梗死(AMI)并发急性心力衰竭(AHF)的临床疗效。方法入选11例AMI患者并发AHF、心功能KillipⅡ～Ⅲ级,在常规标准抗缺血、抗心力衰竭治疗效果欠佳,且伴有血压和心率较基线水平升高的条件下,给予静脉注射艾司洛尔(负荷剂量0.5 mg/kg 1 min内静脉注射,继之0.05 mg.kg-1.min-1持续静脉泵入),观察患者治疗前后生命体征、临床表现及X线胸片肺淤血程度的变化。结果 (1)与治疗前比较,11例患者接受静脉注射艾司洛尔治疗(中位给药时间38.5 h)后,收缩压降低[(109±16)mm Hg比(136±18)mm Hg]、舒张压降低[(61±8)mm Hg比(77±11)mm Hg]、心率减慢[(71±11)次/min比(96±31)次/min],差异均有统计学意义(均为P<0.05);(2)11例患者经治疗后,心力衰竭症状均明显缓解,肺部啰音均明显减少,X线胸片肺淤血程度均明显减轻;(3)11例患者治疗过程中均未发生低血压、严重缓慢性心律失常等不良反应。结论对于AMI患者,若病程中发生以缺血为诱因的AHF且伴有血压、心率较基础水平升高,可在常规治疗基础上,加用静脉注射艾司洛尔,可以获得良好的临床疗效,并且无明显不良反应。

Safety and efficacy of intravenous esmolol hydrochloride injection in patients with acute myocardial infarction complicated with acute heart failure

Objective To study the safety and efficacy of intravenous esmolol hydrochloride injection in patients with acute myocardial infarction(AMI) complicated with acute heart failure(AHF). Methods In this study,we selected 11 patients with AMI complicated with AHF(Killip classⅡ-Ⅲ),whose blood pressure(BP) and heart rate(HR) were increased at the onset of AHF.Besides conventional standard therapy for ischemic heart disease and acute heart failure,all patients received intravenous administration of esmolol hydrochloride(an initial loading dose was 0.5 mg/kg infused over 1 min,followed by a continuous infusion of 0.05 mg·kg-1·min-1).The vital signs,symptoms associated with heart failure,rales and pulmonary congestion on chest X-ray were compared before and after treatment. Results All the 11 patients received intravenous administration of esmolol hydrochloride(the median time for treatment was 38.5 h).(1) Systolic blood pressure(SBP) was decreased from(136±20) mm Hg to(109±16) mm Hg,diastolic blood pressure(DBP) was decreased from(77±11) mm Hg to(61±8) mm Hg and heart rate(HR) was decreased from(96±31) bpm to(71±11) bpm after esmolod therapy(all P<0.05).(2) After treatment,all the patients showed improvement in their symptoms associated with heart failure.Pulmonary rales were reduced and pulmonary congestion on chest X-ray was also lessened.(3) There was no severe adverse reaction such as significant hypotension and severe bradyarrhythmias. Conclusions For patients with AMI complicated with AHF without low blood pressure and heart rate,intravenous administration of esmolol hydrochloride injection is safe and can get better clinical results.