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。

Efficacy and safety of intravenous plus oral metoprolol in patients with acute myocardial infarction

AIM To evaluate the safety and efficacy of intravenous plus oral metoprolol in acute myocardial infarction patients.METHODS Patients within 24h of suspected acute MI onset were randomly allocated metoprolol(n=182) or matching placebo(n=183).Clinical features,average blood pressure and heart rate before and after treatment and major adverse cardiac events(mace) were compared and analyzed in the two groups.RESULTS There were no significant differences in clinical features between metoprolol group and placebo group,except for those with a history of smoking and drinking in metoprolol group(P<0.05).But there were statistical differences in the changes of average blood pressure and heart rate after treatment between the two groups(P<0.05) and statistical differences were also found in ventricular arrhythmias and postinfarction angina between the two groups.No significant differences were found in reinfarction,cerebral infarction,cardiac shock and mortality during the hospitalization.(CONCLUSION) Early intravenous plus oral metoprolol significantly reduces ventricular arrhythmias and postinfarction angina pectoris,but it will not reduce the total in-hospital mortality in patients with acute myocardial infarction.