Abstract:

Objective　To explore the curative effect of metoprolol tartrate combined with amiodarone on arrhythmia in acute myocardial infarction. Methods　The data of 223 patients with acute myocardial infarction and arrhythmia who were admitted to Xianyang Rainbow Hospital from July 2020 to July 2022 were analyzed retrospectively. The patients treated with amiodarone (intravenous drip with 4 ml of amiodarone hydrochloride injection into glucose injection + oral amiodarone hydrochloride tablets 0.2 g/time, 3 times/day) and those treated with amiodarone combined with metoprolol tartrate (oral metoprolol tartrate tablets, 25 mg/time, twice a day) were included in the control group (100 cases) and the combination group (123 cases), respectively. Both groups received treatment for 1 month. In the control group, there were 48 males and 52 females, aged (52.67±13.42) years, 66 patients with cardiac function grade Ⅱ and 34 patients with grade Ⅲ. In the combination group, there were 71 males and 52 females, aged (51.92±13.56) years, 86 patients with grade Ⅱ and 37 patients with grade Ⅲ. The curative effect, the cardiac function and levels of heart rate variability indices before and after treatment, and the occurrence of arrhythmia and drug-related adverse reactions were compared between the two groups. t test and χ² test were used. Results　The total effective rate of the combination group was 95.12% (117/123), while that of the control group was only 86.00% (86/100), with a statistically significant difference between the two groups (P<0.05). After treatment, the cardiac function indexes such as left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), heart rate (HR), and B-type natriuretic peptide (BNP) were significantly improved in both groups (all P<0.05). After treatment, the LVEDD, LVESD, HR, and BNP in the combination group were lower than those in the control group, and the LVEF was higher than that in the control group, with statistically significant differences (all P<0.05). After treatment, the root-mean-square of normal continuous sinus RR interval difference (rMSSD) decreased significantly, while the standard deviation of normal sinus RR intervals (SDNN), percentage of the number of adjacent RR intervals with an interval difference greater than 50 ms (PNN50), and mean standard deviation of sinus RR interval every 5 min within 24 h (SDANN) increased significantly in both groups (all P<0.05). After treatment, the improvements of the above indexes of heart rate variability in the combination group were significantly greater than those in the control group (all P<0.05). The incidences of arrhythmia and drug-related adverse reactions in the combination group [1.63% (2/123) and 5.69% (7/123)] after treatment were lower than those in the control group [11.00% (11/100) and 12.00% (12/100)], and there was a statistically significant difference in the incidence of arrhythmia only (P<0.05). Conclusion　Applying metoprolol tartrate combined with amiodarone to treat patients with acute myocardial infarction and arrhythmia can improve the heart rate variability, alleviate the cardiac injury, and reduce the occurrence of arrhythmia, with significant curative effect.

Key words:

Metoprolol tartrate, Amiodarone, Acute myocardial infarction, Arrhythmia, Observation of curative effect

摘要：

目的　探究酒石酸美托洛尔联合胺碘酮治疗急性心肌梗死心律失常的疗效。方法　对咸阳彩虹医院2020年7月至2022年7月收治的223例急性心肌梗死心律失常患者资料予以回顾性分析，依据患者用药情况将接受胺碘酮（4 ml盐酸胺碘酮注射液融入葡萄糖注射液中静滴+口服盐酸胺碘酮片0.2 g/次、3次/d）和胺碘酮联合酒石酸美托洛尔（酒石酸美托洛尔片口服，25 mg/次，2次/d）治疗的患者分别纳入对照组（100例）和联合组（123例）。两组患者均接受1个月的治疗。对照组男48例，女52例，年龄（52.67±13.42）岁，心功能分级Ⅱ级66例、Ⅲ级34例；联合组男71例，女52例，年龄（51.92±13.56）岁，心功能分级Ⅱ级86例、Ⅲ级37例。比较两组患者治疗效果，治疗前后心功能、心率变异性指标水平，心律失常以及药物相关不良反应发生情况。用t检验、χ²检验。结果　联合组总有效率95.12%（117/123），对照组总有效率86.00%（86/100），两组比较差异有统计学意义（P<0.05）。治疗后两组患者心功能指标如左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、心率（HR）、B型钠尿肽（BNP）等均明显改善（均P<0.05）；治疗后联合组患者LVEDD、LVESD、HR、BNP低于对照组，LVEF高于对照组，差异均有统计学意义（均P<0.05）。治疗后两组患者心率变异性指标正常连续窦性RR间期差值均方根（rMSSD）显著降低，正常窦性RR间期总体标准差（SDNN）、相邻RR间期差值>50 ms的个数所占的百分比（PNN50）、24 h内每5 min窦性RR间期均值标准差（SDANN）水平显著上升（均P<0.05）；治疗后联合组上述各项心率变异性指标改善幅度明显大于对照组（均P<0.05）。联合组患者治疗后心律失常与药物相关不良反应发生率［1.63%（2/123）和5.69%（7/123）］均低于对照组［11.00%（11/100）和12.00%（12/100）］，仅心律失常发生率差异有统计学意义（P<0.05）。结论　急性心肌梗死心律失常患者采用胺碘酮联合酒石酸美托洛尔治疗可以改善患者心率变异性情况，减轻心脏损伤，减少患者心律失常发生，治疗效果显著。

关键词:

酒石酸美托洛尔, 胺碘酮, 急性心肌梗死, 心律失常, 疗效观察