Abstract
目的 探讨不同方式静脉注射美托洛尔对心房颤动(房颤)快速心室率(快室率)伴心力衰竭(心衰)的疗效及安全性.方法 90例房颤快室率伴心衰的患者经常规抗心衰药物治疗后,观察0.5 h,如心率仍>100次/min、血压≥100/60 mm Hg(1 mm Hg=0.133 kPa)者,随机分3组:①美托洛尔注射液10 mg稀释后经微泵静脉滴注(微泵组)1 h;②美托洛尔注射液5 mg于10 min缓慢静脉推注(推注组),观察10 min,如心率仍大于100次/min,血压≥90/60 mm Hg,则再重复一次;③生理盐水对照组.当患者心率≤60 次/min、血压<90/60 mm Hg时注射停止.各组静脉注射药物前及开始时给予美托洛尔注射液或生理盐水后1 h观察症状、体征、心率、血压、肺部啰音、无创血流动力学和血清脑钠肽、心钠肽等指标.结果 美托洛尔2种静脉注射方式给药后,大多数患者心衰症状、体征明显改善,心率、脑钠肽显著下降(F值分别为15.929、14.534,均P<0.01)且比对照组明显(F值分别为5.011,4.559,均P<0.05),收缩压、舒张压有所降低但与对照组差异无统计学意义;无创心功能参数中,微泵组心脏指数、心输出量、每搏指数、每搏输出量、左室射血时间增加且比对照组明显(F值分别为4.435、4.726、3.965、3.450、5.966,均P<0.05),推注组无类似效应.结论 美托洛尔2种静脉注射方式治疗房颤快室率伴心衰均是有效和安全的,微泵方式给药有更好的血流动力学效应。
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