医药学论文：美托洛尔对扩张型心肌病QT间期离散度及室性心律失常变化的研究

　【关键词】 ,扩张型心肌病

　　摘 要：目的：探讨美托洛尔治疗对扩张型心肌病(DCM)患者心电图QT间期离散度(QTd)及室性心律失常的影响。方法：80例DCM患者分为基础治疗组（A组，40例）及基础治疗加美托洛尔治疗组（B组，40例），给予B组在基础治疗上加服美托洛尔25mg/tid,疗程9个月。治疗前后应用24h动态心电图和多普勒超声心动图，观测QTd、QTcd、HR、室性心律失常(VA)如室性早搏(PVC)、非持续性室性心动过速(NSVT)）的发生情况、左心室射血分数(LVEF)。结果：B组QTd、QTcd及室性心律失常（VA）发生率均较A组显著降低(P均< 0.01),左室射血分数(LVEF)较A组明显提高(P< 0.01)，而HR、血压无明显变化(P>0.05)。提示B组疗效明显优于A组。结论：DCM患者长期应用美托洛尔可显著降低QTd、QTcd及VA的发生率,改善心功能,改善预后。

　　关键词： 美托洛尔； 扩张型心肌病； QT离散度； 室性心律失常

　　Study of Metoprolol in Effecting the QTd and Ventricular Arrhythmias in Dilated Cardiomyopathy

　　Abstract： Objective： The aim of the study was to evaluate whether the addition of Metoprolol to conventional therapy in dilated cardiomyopathy(DCM) patients is associated with further benefits in shortening QT intervals dispersions((QTcd) and reducing ventricular arrhythmias(VA). Methods： 80 DCM patients were randomly allocated to two groups (A and B group). A group (conventional therapy group), 40 cases ,with commonly used drugs of cardicglycoside ,diuresis and angiotens inconverting enzyme inhibitor medicine. B group (conventional therapy and Metoprolol group), 40 cases, patients were treated with conventional therapy and Metoprolol 25mg/tid. The course of treatment was 9 months. Before and after the treatment,24 hour Holter was used to monitor HR,VA such as PVC and NSVT, and Doppler ultrasound cardiogram was used to measure left ventricular ejection fraction(LVEF).Results： After 9 month's treatment, LVEF was significantly improved , QTd、QTcd were significantly shortened and VA was markedly reduced in the Metoprolol group compared with that in the conventional therapy group(P< 0.05),but there was no significantly difference between the two groups in the HR and the pressure (P>0.05). Conclusions： Metoprolol coupled with commonly used cardiacglycoside, diuresis and ACEI medicine has a better curative effect in shortening QTd、QTcd , reducing ventricular arrhythmias and improving left ventricular function in dilated cardiomyopathy.

　　Key words： Metoprolol； Dilated cardiomyopathy; QT intervals dispersions; Ventricular arrhythmias

　　室性心律失常是扩张型心肌病(DCM)的严重并发症之一,常可引起猝死。扩张型心肌病心电图QT间期离散度(QTd)的改变及室性心律失常的高危性或易患性已逐渐引起人们的重视［1］。本文旨在探讨应用美托洛尔治疗DCM后QTd及室性心律失常发生率的变化,了解亲脂性β阻滞剂美托洛尔对扩张型心肌病QTd及室性心律失常的临床疗效。

　　1 对象和方法

　　1.1 对象：符合1995年WHO/ISFC工作组关于心肌病定义和分类的报告的DCM标准,选择80例患者, NYHA分级Ⅰ～Ⅱ级48例、客观评分A～B级52例，NYHA分级Ⅲ～Ⅳ级32例、客观评分C～D级28例，合并束支传导阻滞、Ⅱ－Ⅲ度房室传导阻滞、心房纤颤、电解质紊乱、支气管痉挛的慢性阻塞性肺疾病、收缩期血压>160或< 85mmHg(1mmHg=0.133kPa),舒张期血压>100mmHg及心率(HR) 严重心动过缓（心率小于50次/min）者不入选此研究。所有患者随机分两组（两组患者各参数均衡性良好,差异无显著性(P>0.05)），分组如下：A组：（基础治疗组）：40例，男26例，女14例，年龄17～59岁，平均年龄39±21岁。B组：（基础治疗组加美托洛尔治疗组）40例，男24例，女16例，年龄19～57, 平均年龄38±17。