美托洛尔联合胺碘酮对急性心肌梗死冠脉介入围术期交感风暴的预防作用

摘要

目的 评价美托洛尔联合胺碘酮对急性心肌梗死冠脉介入围术期交感风暴的预防作用.方法 选取2016年1月至2018年5月本院行冠脉介入治疗的100例急性心肌梗死患者,按照随机数字法分为对照组与观察组,各50例.所有患者均在围术期经动态心电图证实出现交感风暴,并给予除颤等常规治疗,对照组患者在此基础上给予胺碘酮注射液,观察组患者在对照组治疗的基础上给予美托洛尔注射液.比较治疗前后两组的舒张压(DBP)、收缩压(SBP)、心率(HR)、每搏输出量(SV)、左心室射血分数(LEVF)的变化及并发症发生情况.结果 治疗前,两组患者DBP、SBP、HR水平比较,差异均无统计学意义(均P＞0.05);治疗后,观察组DBP、SBP、HR水平分别为(62.64±3.43)mmHg、(109.74±11.15)mmHg、(74.16±6.30)次/min,均低于对照组,差异均有统计学意义(均P＜0.05);治疗前,两组患者SV、LEVF水平比较,差异均无统计学意义(均P＞ 0.05);治疗后,观察组SV、LEVF水平分别为(65.82±5.35)ml、(55.36±6.44)％,均高于对照组,差异均有统计学意义(均P＜0.05);观察组并发症发生率4.00％,明显低于对照组26.00％,差异有统计学意义(P＜0.05).结论 美托洛尔联合胺碘酮对急性心肌梗死冠脉介入围术期交感风暴具有明显的预防作用,且能有效降低并发症.%Objective To evaluate the effect of metoprolol combined with amiodarone in the prevention of perioperative sympathetic storm during coronary artery intervention in patients with acute myocardial infarction(AMI).Methods 100 AMI patients undergoing coronary artery intervention at our hospital from January,2016 to May,2018 were selected and randomly divided into a control group and an observation group,50 cases for each group.All the patients were confirmed with sympathetic storm by dynamic electrocardiogram in the perioperative period,and were given routine treatment such as defibrillation.The control group were treated with amiodarone injection,and the observation group with amiodarone injection and metoprolol injection.The diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR),stroke volume(SV),and left ventricular ejection fraction(LEVF) before and after treatment as well as complications were compared between the two groups.Results There were no statistical differences in DBP,SBP,HR,SV,and LEVF between these two groups (all P ＞ 0.05).After the treatment,the DBP,SBP,HR SV,and LEVF were (62.64±3.43) mmHg,(109.74±11.15) mmHg,(74.16±6.30) beats/min,(65.82±5.35) ml,(55.36±6.44)％ in the observation group,which were better than those in the control group,with statistical differences (all P ＜ 0.05).The incidence of complications was significantly lower in observation group than in control group (4.00％ vs.26.00％),with a statistical difference (P ＜ 0.05).Conclusions Metoprolol combined with amiodarone had a significant preventive effect on perioperative sympathetic storm in the perioperative period of coronary artery intervention in AMI patients,and can effectively reduce complications.