比索洛尔治疗急性心肌梗死后心力衰竭合并慢性阻塞性肺疾病的临床研究

目的探讨比索洛尔对急性心肌梗死后心力衰竭合并慢性阻塞性肺疾病（COPD）患者心肺功能的影响。方法选取急性心肌梗死后心力衰竭合并COPD患者86例，分别采用药物溶栓（40例）和经皮冠状动脉介入（PCI）（46例）治疗。所有患者在洽疗第2天开始服用富马酸比索洛尔，从2，5mg／d开始，每3天加1．25mg，逐渐增至患者最大耐受剂量10mg／d。共6个月。分别于富马酸比索洛尔治疗前和出院后6个月测定并记录HR、SBP、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、左心室短轴缩短指数（FS）、第1秒用力呼气容积占预计值百分比（FEV，％）及第1秒用力呼气容积占用力肺活量百分比（FEV1／FCV）。结果①药物溶栓者比索洛尔治疗前HR、SBP、LVEDD、LVEF和Fs分别为（106±11）次／min、（131±17）mmHg（1mmHg=0．133kPa）、（59．4±2．7）mm、（35．0±2．9）％和（24±5）％，治疗后分别为（75±6）次／min、（111±8）mmHg、（52．0±3．1）mm、（50，2±4．3）％和（33±5）％；PCI者比索洛尔治疗前分别为（110±13）次／min、（141±7）mmHg、（61．3±3．3）mm、（34．4±2．5）％和（20±4）％，治疗后分别为（75±6）次／min、（120±4）mmHg、（45．0±2．2）mm、（56．7±4．6）％和（40±5）％；各项指标治疗前后的差异均有统计学意义（均P〈0．05）。②药物溶栓和PCI者应用富马酸比索洛尔治疗前后FEV1％、FEV1／FCV差异均无统计学意义（均P〉0．05）。结论比索洛尔治疗急性心肌梗死后心力衰竭合并COPD是安全有效的。

Clinical observation of bisoprolol in the treatment for patients of heart failure after acute myocardial infarction with chronic obstructive pulmonary disease

Objective To evaluate the efficacy and safety of bisoprolol in the treatment for patients of heart failure after acute myocardial infarction with chronic obstructive pulmonary disease （COPD）. Methods A total of 86 patients of heart failure post acute myocardial infarction with COPD were collected. All the patients received thrombolytic therapy or pereutaneous coronary intervention （PCI） respectively according to different myocardial reperfusion treatment strategies. And bisoprolol was administered the second clay after admission for a total of 6 months. Heart rate （HR）, systolic blood pressure （SBP）, left ventricular end diastolic dimension （LVEDD）, e- jection fraction （LVEF） , fractional shortening （FS） , as well as percentage of forced expiratory volume in one sec- ond to predicted value （ FEV1% ） and FEV1 to forced vital capacity ratio （ FEV1/FCV） were all recorded before ad- mission and 6 months after discharge. Results Before drug thrombolytie treatment, HR, SBP, LVEDD, LVEF and FS of patients receiving thrombolytic therapy values were （106 ＋ 11 ）times/rain, （131±17 ）mm Hg, （59.4± 2.7 ） mm, （35.0 ± 2.9 ） % and （ 24 ± 5 ） %, bisoprolol after treatment were （ 75 ±6 ） times/min, （ 111 ± 8 ） mm Hg, （52.0±3.1）mm, （50.2±4.3）% and （33 ±5）%; Before PCI treatment, HR, SBP, LVEDD, LVEF and FS of patients receiving thrombolytic therapy values were（110 ± 13）times/min, （141 ±7）mm Hg, （61.3 ± 3.3 ） mm, （ 34.4 ± 2.5 ） % and （ 20 ± 4 ） %, bisoprolol after treatment were （75 ± 6 ） times/min, （ 120 ± 4 ） mm Hg, （45.0 ± 2.2） mm, （56.7 ± 4.6） % and （40 ± 5 ） % （ P 〈 0.05 ） ; HR, SBP, LVEDD, LVEF and FS were all im- proved after treatment （all P 〈 0.05 ）. There were no difference pertaining to FEV1% and FEV/FCV with the use of bisoprolol （ all P 〉 0.05）. Conclusion The application of bisoprolol in the treatment of heart failure after acute myocardial infarction with COPD is safe and effective.