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目的探讨静脉注射美托洛尔对房颤快速心室率伴心衰的疗效及安全性。方法对房颤快室率伴心衰的患者经常规治疗,观测0.5h,如心率仍>100beat·min-1,血压≥100/60mmHg(1mmHg=0.133kPa)以上的患者,随机分三组,1组为美托洛尔注射液10mg稀释后经微泵静注(微泵组)1h;2组为美托洛尔注射液5mg,10min缓慢静脉推注(推注组),观察10min,如心率仍大于100beat·min-1,血压≥90/60mmHg则再重复给药一次;3组为生理盐水对照组。当心率≤60beat·min-1,血压<90/60mmHg时停止;各组静注药物前及开始给美托洛尔注射液或生理盐水后1h,观察症状、体征、心率、血压、肺部罗音、血流动力学和ANP、BNP等指标。结果静脉注射美托洛尔后大多数患者心衰症状、体征明显改善,心室率、BNP和ANP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无显著差异,无创心功能参数中CO,SI,SV,LVET显著增加并且比对照组明显。结论美托洛尔静脉注射治疗快室率房颤伴心衰是有效和安全的。
Objective To investigate the efficacy and safety of intravenous metoprolol in patients with acute ventricular fibrillation and heart failure. Methods The patients with atrial fibrillation with fast heart rate and heart failure were routinely treated for 0.5 h. Patients with heart rate> 100 beat · min-1 and blood pressure ≥100 / 60 mmHg (1 mmHg = 0.133 kPa) were randomly divided into three groups, Group 1 was treated with metoprolol injection 10mg diluted by micro-pump intravenous injection (micro pump group) for 1h; group 2 metoprolol injection 5mg, 10min slow intravenous injection (bolus group), observed for 10min, as Heart rate is still greater than 100beat · min-1, blood pressure ≥ 90 / 60mmHg is repeated once again administered; 3 groups of saline control group. When the heart rate ≤ 60beat · min-1, blood pressure <90 / 60mmHg stop; each group before intravenous injection and the beginning of metoprolol injection or saline 1h, observe the symptoms, signs, heart rate, blood pressure, lung Luo Tone, hemodynamics and ANP, BNP and other indicators. Results Most patients with intravenous metoprolol showed significant improvement in their symptoms and signs of heart failure. Their ventricular rate, BNP and ANP decreased significantly compared with those in the control group, while systolic and diastolic blood pressure decreased, but no significant difference with the control group Function parameters CO, SI, SV, LVET significantly increased and significantly more than the control group. Conclusion Intravenous injection of metoprolol is effective and safe for the treatment of fast-acting atrial fibrillation and heart failure.