【摘要】 目的:观察美托洛尔注射液早期治疗非ST段抬高急性心肌梗死患者血清氨基端脑钠肽前体(NT-ProBNP)水平变化。方法:将69例非ST段抬高急性心肌梗死患者(Killip分级Ⅰ～Ⅱ级)随机分成两组,治疗组34例为症状出现24 h内予静脉注射美托洛尔,对照组35例为常规治疗。两组均在入选6 h内、第7天和第28天检测血清NT-ProBNP浓度以及监测第1天、第28天左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)、室上性和室性心律失常计数。结果:血清NT-ProBNP浓度变化:治疗组第7天、第28天血清NT-ProBNP浓度分别为(155.43±30.56)pg/ml、(105.43±30.56)pg/ml与对照组第7天、第28天(289.9±42.3)pg/ml、(209.9±42.3)pg/ml比较明显下降,差异有统计学意义(P<0.05);且治疗组第7天血清NT-ProBNP浓度与最初6 h血清NT-ProBNP浓度(320.2±50.5)pg/ml相比也明显下降,差异有统计学意义(P<0.05)。69例患者28天内死亡4例患者与非死亡65例患者平均血清NT-ProBNP水平分别为〔(620.8±160.5)pg/ml、(187.8±89.6)pg/ml〕,两者比较差异有统计学意义(P<0.05)。心脏超声变化:治疗组第1天和第28天的前后差值与对照组第1天和第28天的前后差值比较,左心室舒张末期内径、左心室收缩末期内径显著减少,差异均有统计学意义(P<0.05)。动态心电图监护:治疗组第1天和第28天的前后差值与对照组第1天和第28天的前后差值比较,室上性心律失常计数、室性心律失常计数显著升高,差异均有统计学意义(P<0.05)。结论:非ST段抬高急性心肌梗死患者早期应用美托洛尔注射液治疗是安全的,并能显著降低血清NT-ProBNP水平,降低心律失常发生,改善心室重塑。死亡患者血清NT-ProBNP浓度显著升高。更多还原

【Abstract】 Objective:To investigate plasma concenrtration of NT-ProBNP for metoprolol injection in patients with non-ST-elevation acute myocardial infarction(AMI).Methods: A total of 69 patients with non-ST-elevation AMI were randomly divided into two groups.Treatment group: n=34,the patients were treated with metoprolol injection within 24 hours of symptoms appeared;Control group: n=35,the patients were treated with routine medication.Plasma NT-ProBNP concentrations were measured in both groups at 6 hours,7 days and 28 days respectively.Left ventricular end-diastolic dimension(LVEDD),Left ventricular end-systolic dimension(LVESD),super-ventricular arrhythmia and ventricular arrhythmia were monitored at 24 hours and 28 days respectively.Results:Plasma concentration of NT-ProBNP was significantly decreased in treatment group at 7 days and 28 days(155.43±30.56 pg/ml and 105.43±30.56 pg/ml)than in control group(289.9±42.3 pg/ml and 209.9±42.3 pg/ml),(P<0.05).4 patients died,1 in treatment group and 3 in control group.NT-ProBNP concentration in died patients(620.8±160.5 pg/ml)was significantly higher than in alive patients(187.8±89.6 pg/ml),(P<0.05).More changes of LVESD and LVEDD were found in treatment group(1.3±0.1 mm and 2.1±0.3 mm)than in control group(4.7±0.4 mm and 6.9±0.8 mm),(P<0.05).Changes of the count for super-ventricular arrhythmia or ventricular arrhythmia at the first day and 28 days were significantly increased in treatment group(199.0±42.2 and 509.8±95.4)than in control group(80.9±35.2 and 200.7±46.5),(P<0.05).Conclusion: Metoprolol injection was safe in patients with non-ST-elevation AMI.Plasma concentration of NT-ProBNP was significantly lower in treatment group than in control group.Super-ventricular or ventricular arrhythmia was decreased and left ventricular remodeling was improved by metroprolol injection in non-ST-elevation AMI patients.更多还原