摘要
目的以硝酸甘油(NTG)作对照,观察美托洛尔(metoprolol)治疗不稳定心绞痛患者的临床疗效和安全性。方法采用随机、平行对照试验。共入选患者40例随机分为静脉注射美托洛尔组和静脉滴注NTG组。美托洛尔组首先采用静脉注射美托洛尔5mg×3支,共15mg,按1mg/min速度静脉注射,完成静注5mg后,观察3～5min,根据患者心率和收缩压变化决定是否继续用药,若静脉注射过程中患者心率下降至50次/分以下或收缩压<90mmHg,则停止后续用药。静脉注射完成15min后,收缩压在90mmHg以上,心率≥50次/min,改用口服普通美托洛尔25～50mg,6h1次,48h后改用50～100mg,q12h维持治疗。NTG组从20μg/min起始,最大用量80～100μg/min,持续静滴48h。以难治性心绞痛、急性心肌梗死、死亡为观察的终点。结果在改善不稳定性心绞痛患者的症状和心电图方面美托洛尔明显优于NTG。美托洛尔比NTG更明显地降低了心率和心肌耗氧指数(收缩压×心率)。用药后美托洛尔组较NTG组难治性心绞痛发生明显减少。美托洛尔组较NTG组心率明显减缓(≤50次/min)(P<0.01),但绝大多数患者均可耐受。美托洛尔组较NTG组降压作用明显,但收缩压降低于90mmHg者少,绝大多数患者均可耐受。结论静脉注射美托洛尔治疗不稳定性心绞痛安全、有效,可降低难治性心绞痛发生的风险和总的缺血事件发生的风险。
Objective To observe the security in treating unstable angina by metoprolol with nitroglycerin. Methods a randomized,parallel group trial was conducted. A total of 40 eligible patients were enrolled. They were randomized either to metoprolol or nitroglycerin treatment. In the group of metoprolol group, by mainline for 15mg first at the rate of 1mg per minus. Observe 3～5 min after 5mg mainline. Whether continues reuse was based on heart rate and constriction. If the heart rate fall under 50 or the contract pressure under 90mmHg, stop the test. If the heart rate above 50 or the contract blood pressure above 90mmHg after 15 min then change into 25～50mg by taking orally every 6 hour. After 48 hours treatment take 50～100mg every 12 hour. In group nitroglycerin, nitroglycerin from 20μg/min to 80～100μg/min for mainline 48 hour.The endpoints included refractory angina pectoris, acute myocardial infarction, death ,emergency Results effects of metoprolol were better to NTG on the improvement of symptom and electrocardiogram. compare to NTG, metoprolol lowered heart rate and myocardial oxygen consumption index(systolic pressure×heart rate). compare to NTG, after treatment, the onsets of refractory angina pectoris were reduced more significantly in the metoprolol group. The patients whose heart rate were reduced(≤50 beats/min) significantly in the metoprolol group were more than in the nitroglycerin group (P<0.01).But these patients could tolerate the lower heart rate well in the metoprolol group. the blood pressure was fell evidently compare to nitroglycerin Conclusions Metoprolol is effective and safe for patients with unstable angina pectoris. It may significantly lower the risk of refractory angina pectoris.
出处
《中国医药导报》
CAS
2006年第21期5-7,共3页
China Medical Herald
