琥珀酸美托洛尔缓释片在高龄老年冠心病患者中的应用

目的观察琥珀酸美托洛尔在高龄老年冠状动脉粥样硬化性心脏病（冠心病）患者中的疗效、耐受性和安全性。方法将临床确诊的96例高龄冠心病患者分为两组，年龄（82．7±3．5）岁。两组均给予常规的冠心病药物治疗，对照组采用美托洛尔普通片（52．65±10．26）mg／d，治疗组采用琥珀酸美托洛尔缓释片（53．12±11．53）mg／d，比较两组用药6个月患者心肌梗死及心绞痛发病率、心率的变化、心力衰竭发作住院率以及服药依从性。结果两组均能良好耐受较大剂量美托洛尔，两组心率均有所下降，两组间比较，差异无统计学意义（9．25±3．54）次／main vs．（9．28±2．89）次／min），P〉0．05]，但对照组心率变异范围较大。动态心电图显示在清晨5：00～9：00时．治疗组心率控制明显低于对照组（58．83±2．35）次／min vs．（67．27±3．12）次／min），P〈0．01]。两组心肌梗死发病率比较，差异无统计学意义（P〉0．05），但治疗组每周心绞痛次数（1．6±0．3）次vs．（0．9±0．2）次，P〈0．01]以及心绞痛持续时间（7．4±2．6）min／次VS．（12．8±5．5）min／次），P〈0．01]明显低于对照组，尤以清晨5：00—9：00时晨间心绞痛发作减少更为明显。治疗组心力衰竭发作住院次数较对照组明显减少，差异有统计学意义（0．7±0．1vs.0．9±0．2，P〈0．05）。治疗组服药依从性明显高于对照组，差异有统计学意义85．4％（41／48）vs．62．5％（30／48），x^2=6．544，P=0．019]。结论高龄老年冠心病患者服用琥珀酸美托洛尔可以明显降低心率变异性，降低晨间心率，减少心绞痛发作次数和持续时间，减小心力衰竭发作住院率，提高患者服药依从性。

Effect of succinic acid metoprolol extended release tablets in elder patient with coronary heart disease

Objectives To observe the effect, toleration and safety of succinic acid metoprolol in elder patient with coronary heart disease （CHD）. Methods Ninety six eider patients diagnosed as CHD, mean age （87.2±3.5） years old, were divided into two groups. Besides routine treatment, patients in control group were given tartraric acid metoprolol （52.65±10.26）mg/d, while patients in treatment group were given succinie acid metoprolol （53.12±11.53）mg/d. Incidence of myocardial infarction （MI） and angina pectoris attacks, change of heart rate （HR）, admission rate due to heart failure （HF）, as well as the compliance during six months treatment were observed and compared between the two groups. Results Patients in both groups could tolerate large dosage of metoprolol. The mean HR decreased in both groups. Though no obvious difference of heart rate decrease existed between the two groups （9.25±3.54） beats/min vs. （9.28±2.89） beats/min, P〉0.05], the range of variation was larger in control group. Dynamic electrocardiogram showed that average heart rate of treatment group was significantly lower than that of control group from 5 Am to 9 Am （58.83coronary heart disease ; metoprolol ; old people ; eld2.35） beats/rain vs. （67.27±3.12） beats/rain, P〈0.01 ]. Although there was no significant difference in the incidence of MI between the two groups, the frequency in a week（ 1.6±0.3 vs. 0.9±0.2,P〈0.01 ） and duration of angina I （7.4±2.6） rain vs. （12.8±5.5） rain,P〈0.01 ] in the treatment group were obviously lower than those in control group, especially during 5 AM to 9 AM. The admission rate due to HF in treatment group was also lower than that in control group （0.7±0.1 vs. 0.9±0.2,P〈0.05）. Besides, compliance was much better in treatment group than that in control group 185.4% （41/48）vs. 62.5%（30/48）, X^2=6.544,P=0.019]. Conclusions Succinie acid metoprolol can decrease heart rate variability, lower HR in the morning, reduce frequency and duration of angina and admission rate due to HF, and promot compliance of the elder patients as well.