心肌梗死后慢性心功能不全并非持续性室性心律失常的药物治疗分析

发布时间：2018-04-10 03:13

本文选题：心肌梗死　切入点：慢性心功能不全　出处：《新乡医学院》2017年硕士论文

【摘要】：目的通过临床试验研究探索小剂量倍他乐克联合胺碘酮、小剂量倍他乐克联合美西律与单一使用倍他乐克对心肌梗死后慢性心功能不全并非持续性室性心律失常的患者的疗效对比,探讨最佳治疗方案,指导临床用药。方法本研究选取于心内科就诊的心肌梗死后慢性心功能不全并非持续性室性心律失常的患者共96例,随机分3组,在积极治疗心肌梗死后慢性心功能不全基础上,小剂量倍他乐克联合胺碘酮组(A组)给予倍他乐克12.5mg/次,2次/d,并加用盐酸胺碘酮片:第一周,200mg/次,2次/d,口服;自第二周起,每次剂量不变,用药次数改为1次/d。小剂量倍他乐克联合美西律组(B组)给予倍他乐克12.5mg/次,2次/d,并加用盐酸美西律片100mg/次,3次/d。对照组(C组)给予倍他乐克12.5mg/次,2次/d,1周后根据患者耐受情况可最大加量至25mg/次,2次/d。三组均治疗4周为一个疗程。观察记录受试者用药前后的24小时动态心电图、超声心动图,记录其早搏及短阵室速次数变化及心功能变化、实验前后QT离散度(QT dispersion,QTd)变化、用药后相关不良反应等。结果1.小剂量倍他乐克联合胺碘酮、小剂量倍他乐克联合美西律在减少室性早搏、短阵室速方面的有效率(84.38%、83.50%)均显著高于单一用药组(59.38%)(P0.05)。2.三组患者用药后心功能各项指标均较各组用药前好转(P0.05);小剂量倍他乐克联合胺碘酮组NT-proBNP、左心功能、心衰超声指数等指标的改善明显优于单一用药组(P0.05)。小剂量倍他乐克联合胺碘酮在改善心功能方面效果明显优于单一用药组(P0.05),但小剂量倍他乐克联合美西律组在改善心功能方面较单一用药物组无明显优势(P0.05)。3.治疗后三组的QTd水平均显著小于本组治疗前(P0.05),且两个联合用药组QTd水平均显著小于对照组(P0.05)。4.两药物联用组住院率及心脏事件发生率明显少于对照组(P0.05)。三组用药均发生不同程度的不良反应。小剂量倍他乐克联合胺碘酮肝损伤的不良反应较为明显。结论1.小剂量倍他乐克联合胺碘酮、小剂量倍他乐克联合美西律在减少室性早搏、减少短阵室速发作次数上疗效优于单一使用倍他乐克;同时两组联合用药组患者的QTd水平较对照组明显减小;两组联合用药组患者的心脏事件及再住院率明显低于对照组。2.小剂量倍他乐克联合胺碘酮在改善心功能方面优于单一使用倍他乐克;但小剂量倍他乐克联合美西律在改善心功能方面较单一使用倍他乐克无明显优势。倍他乐克联合胺碘酮用药时产生的肝损伤发生率较高。
[Abstract]:Objective to explore small dose Betaloc combined with amiodarone through clinical trials, small dose Betaloc combined with mexiletine and single use Betaloc curative effect on myocardial infarction after chronic heart failure is not sustained ventricular arrhythmias in patients, to explore the best treatment method of the clinical medication. Study on Department of Cardiology in our hospital after myocardial infarction, chronic heart failure is not sustained ventricular arrhythmias in patients with a total of 96 cases were randomly divided into 3 groups, in the active treatment after myocardial infarction and chronic heart failure on the basis of small dose Betaloc combined with amiodarone group (A group) was given Betaloc 12.5mg/, 2 /d, and with Amiodarone Hydrochloride Tablets: the first week, 200mg/ times, 2 times /d, oral; since the second week, each dose of medication is unchanged, 1 /d. of low dose Betaloc combined with mexiletine group (B group) was given Betaloc 12 .5mg/, 2 /d, and with Mexiletine Hydrochloride Tablets 100mg/, the 3 /d. control group (group C) was given Betaloc 12.5mg/ times, 2 times /d, 1 weeks according to the patients tolerated the maximum dosage to 25mg/ times, 2 times /d., three groups were treated for 4 weeks as a course. Observe and record the subjects' dynamic ECG 24 hours before and after the treatment, echocardiography, cardiac function and the change of record number of beats and paroxysmal ventricular tachycardia, before and after the experiment of QT dispersion (QT dispersion, QTd) changes after medication related adverse reactions. Results 1. small dose Betaloc combined with amiodarone, small the dose of Betaloc combined with mexiletine in reducing ventricular premature beats, paroxysmal ventricular tachycardia in terms of efficiency (84.38%, 83.50%) were significantly higher than that of single drug group (59.38%) (P0.05).2. of the three groups of patients after heart function indexes were lower than before treatment were improved (P0.05); low dose of times he metoprolol combined with amiodarone group NT-proBNP And the left ventricular function improved significantly better than the single drug group of heart failure echocardiography index (P0.05). The small dose Betaloc combined with amiodarone in improving heart function was better than the single drug group (P0.05), but a small dose of Betaloc combined with mexiletine group in improving heart function than single drug no obvious advantage (P0.05).3. QTd the three groups after treatment were significantly less than before treatment in treatment group (P0.05), and the two combination therapy group QTd levels were significantly lower than the control group (P0.05).4. two drug group hospitalization rate and incidence of cardiac events was significantly less than the control group (P0.05 three). Group had different degrees of adverse reactions. Small dose of metoprolol combined with amiodarone adverse reaction grams liver injury obviously. Conclusion 1. small dose Betaloc combined with low-dose amiodarone and Betaloc combined with mexiletine in reducing ventricular premature beat, reduce short array Ventricular tachycardia episodes on curative effect than single use of Betaloc; while two group combination group of patients with QTd levels than the control group obviously decreased; the two group combination group of patients with cardiac events and readmission rate was significantly lower than the control group.2. low-dose Betaloc combined with amiodarone is better than the single use of Betaloc in on the improvement of cardiac function; but a small dose of Betaloc combined with mexiletine in improving heart function than the single use of Betaloc. Liver injury produced no obvious advantage of Betaloc combined with amiodarone treatment had a higher incidence.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541;R542.22

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