不同剂型美托洛尔片治疗扩张型心肌病100例临床疗效分析

摘要

Objective To investigate the curative effect of metoprolol tartrate and metoprolol succinate sustained release tablets in the treatment of dilated cardiomyopathy. Methods On the basis of optimal anti heart failure therapy,100 patients with dilated cardiomyopathy were randomized to receive either metoprolol tartrate tablet at an initial dose of 6.25 mg 2 times a day or metoprolol succinate sustained release tablet 11. 875 mg once daily. Patients well tolerated were administered uptitrated to double dose every week until the target dose or maximum tolerated dose. Then maintained for 12 weeks to observe clinical responses. Results After treatment, addition of metoprolol sustained release tablets provided a better improvement in New York Heart Association classification compared with metoprolol tartrate(γ2=7.71 ,P＜0.05) tablets. In both groups, systolic and diastolic blood pressure were decreased(P＜0.05) ,and LVEDd,LAD were reduced while LVEF increased significantly(P＜0.01) ,with Metoprolol sustained release tablets group more obvious but no significant difference between groups. The fastest,the slowest and average heart rate also had declining trends in two groups,but only the average heart rate was decreased significantly in metoprolol sustained release tabletsgroup(t=2.186,P=0.035).Inaddition,the 24 hour beats of premature ventricular contractions were reduced obviously only in metoprolol sustained release tablets group(t= 2.637,P= 0. 012). Occurrence of ventricular tachycardia was also found decreased although with no significant difference. None group presented statistical significance in the longest RR interval prolongation. Conclusion Both metoprolol tartrate and metoprolol succinate sustained release tablets can improve cardiac function in dilated cardiomy opathy. Especially,metoprolol succinate sustained release tablets could else reduce the incidence of ventricular arrhythmias,revealing a better efficacy and safety.%目的 探讨酒石酸美托洛尔和琥珀酸美托洛尔缓释片治疗扩张型心肌病的临床疗效.方法 将100例扩张型心肌病患者分为两组.在标准心力衰竭治疗基础上,分别给予酒石酸美托洛尔6.25 mg每日2次,或琥珀酸美托洛尔缓释片11.875 mg每日1次,如无特殊,每周加倍,直至靶剂量或最大耐受剂量,并维持治疗12周,观察临床疗效.结果 治疗后两组患者的纽约心功能分级均明显改善,琥珀酸美托洛尔组优于酒石酸美托洛尔组(P＜0.05).两组收缩压、舒张压均降低(P＜0.05),左室舒张末内径(LVEDd)、左房内径(LAD)明显缩小,左室射血分数(LVEF)明显增加(P＜0.01),琥珀酸美托洛尔组更为明显,但组间差异尚无统计学意义.最快心率、最慢心率及平均心率在两组均有下降趋势,但仅平均心率在琥珀酸美托洛尔组下降有统计学意义(t=2.186,P=0.035);琥珀酸美托洛尔组治疗后24 h室性早搏次数明显下降(t=2.637,P=0.012),室性心动过速心搏数及发生阵数亦呈明显下降趋势.两组最长RR间期延长的差异均无统计学意义.结论 酒石酸美托洛尔和琥珀酸美托洛尔缓释片均可改善扩张型心肌病患者心功能,琥珀酸美托洛尔缓释片还可减少室性心律失常发生率,疗效更佳,安全性好.