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目的探讨美托洛尔对应用血管紧张素转换酶抑制剂(ACEI)等基础治疗的慢性心力衰竭(CHF)并快速房颤患者心室率及心功能的疗效及机制。方法选择CHF并快速房颤患者63例,均给予基础治疗(洋地黄、利尿剂、ACEI),并随机分为治疗组(35例)和对照组(28例),治疗组加用美托洛尔。比较治疗前后静息、活动时的心室率、心功能及运动耐量及左室射血分数(LVEF)。结果治疗组应用美托洛尔后,对静息及活动后心室率均能满意控制,同治疗前相比P均<0.01,左室射血分数(LVEF)显著增高(P<0.01),患者运动耐量明显改善。对照组治疗后静息及活动后心室率无明显下降,甚至反而升高(P>0.05),LVEF无改善(P>0.05)。结论单纯ACEI等基础治疗不能有效控制CHF并快速房颤心室率,美托洛尔可有效地控制其静息及活动后心室率,改善LVEF,提高临床疗效。作用机制与美托洛尔可抑制神经-内分泌的激活有关。
Objective To investigate the effect and mechanism of metoprolol on ventricular rate and cardiac function in patients with chronic heart failure (CHF) and other essential AF patients treated with angiotensin converting enzyme inhibitor (ACEI). Methods Sixty-three patients with CHF and rapid AF were given basic treatment (digitalis, diuretic, ACEI) and were randomly divided into treatment group (n = 35) and control group (n = 28) Seoul Ventricular rate, heart function, exercise tolerance and left ventricular ejection fraction (LVEF) were compared between before and after treatment. Results After treatment with metoprolol, the ventricular rate at rest and after exercise were both controlled satisfactorily, P <0.01 and LVVEF increased significantly (P <0.01) Significantly improved tolerance. The resting and active ventricular rate did not decrease or even increase in the control group (P> 0.05), but no improvement in LVEF (P> 0.05). Conclusions Simple ACEI and other basic treatment can not effectively control CHF and rapid ventricular rate of atrial fibrillation. Metoprolol can effectively control resting and post-operative ventricular rate, improve LVEF and improve clinical efficacy. Mechanism of action and metoprolol can inhibit neuro-endocrine activation.