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目的探讨静脉注射美托洛尔对心房颤动伴快速心室率(房颤快室率)并发舒张性心功能不全患者疗效和安全性以及对心钠肽(ANP)、脑钠肽(BNP)的影响。方法对房颤快室率患者常规治疗,观测0.5 h,心率仍>100次.min-1、血压≥100/60 mmHg(1 mmHg=0.133 kPa)患者90例,随机分3组。微泵治疗组30例,美托洛尔注射液10mg,稀释后经微泵静脉注射1 h;静推治疗组30例,美托洛尔注射液5 mg,10 min缓慢静脉推注,观察10 min,如心率仍>100次.min-1,血压≥90/60 mmHg则再重复给药1次。对照组30例,缓慢静脉推注0.9%氯化钠注射液20 mL;当患者心率≤60次.min-1或(和)血压<90/60 mmHg时停止静脉推注;各组静注药物前及开始给美托洛尔注射液或0.9%氯化钠注射液后1 h,观察症状、体征、心率、血压、肺部音、血清ANP、BNP等指标。结果静脉注射美托洛尔后大多数患者心力衰竭症状、体征明显改善,心室率、ANP、BNP显著下降且比对照组明显,收缩压、舒张压有所降低,但与对照组比较差异无显著性(P>0.05)。结论静脉注射美托洛尔治房颤快室率患者,可以改善临床症状和体征,减慢心室率,降低ANP、BNP。
Objective To investigate the efficacy and safety of intravenous metoprolol in patients with atrial fibrillation with rapid ventricular rate (AF) and patients with diastolic heart failure, and the effects on the levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) . Methods A total of 90 patients with atrial fibrillation fast-room rate were randomly divided into three groups. After 0.5 hour of observation, the heart rate was still> 100 times .min-1 and blood pressure was 100/60 mmHg (1 mmHg = 0.133 kPa). 30 patients in the micro-pump group and 10 mg metoprolol injection were intravenously injected with micro-pump for 1 h after dilution. Thirty patients in the push-push group received metoprolol injection 5 mg for 10 min. min, such as heart rate is still> 100 times. Min-1, blood pressure ≥ 90/60 mmHg then repeat the administration 1 times. Control group 30 patients, slow intravenous injection of 0.9% sodium chloride injection 20 mL; when the patient heart rate ≤ 60 times .min-1 or (and) blood pressure <90/60 mmHg stop intravenous injection; intravenous drug Symptoms, signs, heart rate, blood pressure, lung sound, serum ANP, BNP and other indicators were observed before and at 1 h after metoprolol injection or 0.9% sodium chloride injection. Results Most patients with heart failure symptoms and signs of heart failure were significantly improved after venous injection of metoprolol, the ventricular rate, ANP and BNP decreased significantly compared with the control group, while the systolic and diastolic blood pressure were decreased, but no significant difference compared with the control group (P> 0.05). Conclusion Intravenous metoprolol in patients with atrial fibrillation fast room rate, can improve clinical symptoms and signs, slow down the ventricular rate, reduce ANP, BNP.