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美托洛尔对急性心肌梗死患者心功能动态变化的影响
周惠云,甄胜西,周启棣
北京大学深圳医院,深圳口岸医院,北京大学深圳医院
摘要:
目的:探讨β-受体阻滞剂美托洛尔对心交感神经的影响及心交感神经对心肌细胞分泌NT-proBNP的影响,为β-受体阻滞剂对AMI患者改善心功能的应用提供更多、更有力临床依据。方法:入选急性心肌梗死患者78例,随机分为美托洛尔治疗组和对照组,2组均行常规治疗,治疗组入院后即开始使用美托洛尔治疗,对照组未使用任何β-受体阻滞剂,2组维持治疗12个月,监测2组血浆去甲肾上腺素(norepinephrine,NE)、B型钠尿肽前体代谢产物(pro-B-type natriuretic peptide,NT-proBNP)及心功能超声指标左室舒张末容积(left ventricular end diastolic volume,LVEDV)、左室射血分数(left ventricular ejection fraction,LVEF)的动态变化,并严密随访心力衰竭事件的发生情况,比较2组间的差异。结果:在监测、随访12个月期间,治疗组血浆NE、NT-proBNP含量及LVEDV均显著低于对应的常规治疗组,而LVEF显著高于对照组(P<0.05);治疗组心力衰竭发生率亦显著低于对照组(P<0.01)。结论:美托洛尔可遏制心交感神经作用和心肌细胞分泌NT-proBNP,有益于心AMI患者心功能改善。
关键词:  β-受体阻滞剂、心肌梗死、去甲肾上腺素、B型利钠肽、心功能
DOI:10.11851/j.issn.1673-1557.2013.04.005
分类号:
基金项目:
Effect of Metoprolol on Dynamic Changes of Cardiac Function in Patients after Occurrence of Acute Myocardial Infarction
Zhou Huiyun,Zhen Shengxi and Zhou Qidi
Department of Emergency,Peking University Shenzhen Hospital,Shenzhen KouanHospital,Department of Emergency,Peking University Shenzhen Hospital
Abstract:
Objective: To discuss the influence of β-receptor blocker on cardiac sympathetic nerve and its influence on Secretion of NT-proBNP, and to offer more and stronger basis for β-receptor blocker improving AMI patients. Methods:Seventy-eight patients with acute myocardial infarction were selected and randomly divided into two groups: Group treated by Metoprolol and matched Group by no Metoprolol. At the same time they both were treated by the same conventional therapy and clinical follow-up for 12 months. In the two groups, the concentrations of plasma Norepinephrine and NT-proBNP were measured before the treatments and after 2 months, 4 months ,6 months, 8 months, 10 months and 12 months of treatments; meanwhile ultrasound indicators including left ventricular end diastolic volume(LVEDV) and left ventricular ejection fraction(LVEF) were measured and the events about heart failure were supervised. Results: In Group treated by Metoprolol, concentrations of plasma norepinephrine, NT-proBNP and LVEDV showed statistically significant decreases compared to the matched Group by no Metoprolol , meanwhile LVEF showed statistically significant increases,P<0.05; also the occurrence rate of heart failure was lower significantly in Group treated by Metoprolol than the matched Group by no Metoprolol ,P<0.01.Conclusion: Metoprolol can be helpful on the effect that cardiac sympathetic nerve can influence the discharge of NT-proBNP by cardiac cell.
Key words:  beta adrenergic blockade  myocardial infarction  norepinephrine  B-type natriuretic peptide  cardiac functionnction
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