摘要
目的探讨卡维地洛对心肌梗死后窦性心率震荡的影响及窦性心率震荡与交感神经的关系。方法入选急性心肌梗死患者66例，随机分为观察组与对照组，观察组予卡维地洛治疗12个月，对照组则常规予以美托洛尔治疗12个月，所有病例于β受体阻滞剂治疗前、治疗后6个月、12个月行24hHolter检查及血浆去甲肾上腺素（NE）和肾上腺素（E）量的检测，随访新的心脏事件发生情况。用ECGLABTOP版HOLTER软件取得窦性心率震荡参数：震荡起始（TO）及震荡斜率（TS）值，分析比较两组各阶段数值、新的心脏事件发生率及TO、TS值与血浆NE和E间相关性。结果β-受体阻滞剂治疗前，两组TO、TS、血浆NE和E量差异均无统计学意义。在治疗6个月及12个月后，对应阶段观察组NE、E量、TO值显著低于对照组，TS显著高于对照组（P〈0．05）。治疗后观察组NE、E及TO值逐步显著下降，TS逐步显著上升，三个阶段的差异有统计学意义（P〈0．05）；对照组NE和E有所下降，TS有所上升，但三个阶段的差异无统计学意义（P〉0．05）。随访12个月中，观察组新的心脏事件发生率亦显著低于对照组（P〈0．05）。TO、TS与NE、E指标之间的存在显著相关性（P〈0.05）。结论卡维地洛可阻滞心肌梗死后交感神经分泌，可能更有效地预防心肌梗死后新的心脏事件发生；交感神经分泌的变化在窦性心率震荡过程中起重要作用，窦性心率震荡的变化可能对新的心脏事件发生有预测价值。
Objective To investigate the effects and relations of carvedilol on heart rate turbulence and secretion of sympathetic nerve in patients with myocardial infarction. Methods Sixty-six patients selected with acute myocardial infarction were randomized to enroll into experimental group （ n = 33 ） treated with carvedilol and control group（n = 33） treated with metoprolol for 12 months follow-up treatment. The concentrations of plasma norepinephrine（NE） and epinephrine（E） and 24 hour Holter monitoring were measured respectively before the treatment,after 6 months and 12 months; and new cardiac events were supervised for all cases. Quantification of heart rate turbulence（HRT） were carried out by computer analyzing two factors：turbulence onset（TO） and turbulence slope（TS） from the data of 24 hour Holter monitoring. NE, E,TO, TS and the occurrence rare of new cardiac events were compared between two groups and in different times of treatment. The correlation between TO,TS and NE, E was analysed. Results Before the treatment, there was no significant differences between two groups to the comparisons of NE, E, TO and TS（P 〉0.05）. After treating 6 and 12 months, NE,E and TO of experimental group were all lower than control group＇ s significantly, accordingly TS were all higher（ P 〈 0.05）. By comparing 3 times（before, after 6 and 12 months of treatment）, NE,E and TO of two groups dropped, meanwhile TS rose;experimental group showed significant changes（ P 〈 0.05 ）, but control group showed no significant differences（ P 〉 0.05 ）. The occur- rence rate of new cardiac events of experimental group was lower than control group＇s significantly（ P 〈 0.05）. There was significant correlation between NE, E and TO, TS（P 〈 0, 05）. Conelnsion Carvedilol treatment can block the secretion of sympathetic nerve after myocardial infarction and prevent the occurrences of new cardiac events significantly; the changes of the secretion of sympathetic nerve can play an importa
出处
《中国基层医药》
CAS
2008年第4期533-535,共3页
Chinese Journal of Primary Medicine and Pharmacy
基金
广东省深圳市科技计划立项课题（200404107）
关键词
心肌梗死
卡维地洛
心率
心电描记术
Myocardial infarction
Carvedilol
Heart rate
Electrocardiography
