摘要
目的评估β阻滞剂美托洛尔对急性心肌梗死（AMI）住院患者血压及心率的影响。方法人选发病24h内可疑AMI的住院患者，且无研究药物明确禁忌证的。将人选对象随机分为8阻滞剂美托洛尔治疗组或相应安慰剂组。首先静脉注射美托洛尔或安慰剂5mg，间隔2～3min后，再注射5mg，注射3次共15mg；然后美托洛尔／安慰剂口服第1天为50mg，4次／d,第3天起为200mg，1次／d。疗程最长4周或出院。主要研究指标是血压、心率、其他不良反应、病死率及其他并发症。结果1999—11—2000-05，10家大中医院完成预试验研究236例，其中随机分到美托洛尔治疗组120例，安慰剂对照组116例。治疗前两组患者基础临床特征相似。当天进行静脉注射的美托洛尔与安慰剂组分别为100％与99．2％，完成3支静脉注射的为87．9％与95．8％；住院期提前停用的为24．4％与13．6％。治疗后，美托洛尔组低血压、心动过缓发生率均明显高于安慰剂组（P≤0．05～0．01）；两组总病死率（7．8％VS8．4％）相似（P=0．86），其他并发症也无明显差异。美托洛尔静注及口服后治疗组心率明显均低于对照组（P〈0．01），血压略低于安慰剂组。结论美托洛尔早期治疗AMI住院患者低血压及心动过缓发生率较高。
Objective The aim of this study is to investigate the effect of metoprolol on blood pressure and heart rate in patients with acute myocardial infarction （AMI）. Methods The study is a part of large-scale, randomised controlled trial of Chinese Cardiac Study-Ⅱ （CCS-2）. Inhospital patients with 24 hours of onset of symptoms of AMI, and no contraindication to β-blockade were randomly allocated to metoprolol or placebo group. Treatment was initiated as soon as possible after admission. Metoprolol or placebo 15 mg was given bolus intravenously followed by 5 mg every 2--3 minutes. Oral metoprolol or placebo 50 mg was given, every 6 hours for 2 days. Thereafter metoprolol or placebo 200 mg was administered every day in the following 4 weeks or until discharge. Blood pressure, heart rate, side effects, mortality and other complications were observed. Results From Nov 1999 to May 2000, 236 patients with AMI were admitted to 10 hospitals and were assigned to receive metoprolol （n= 120 ） or placebo （ n= 116）. Baseline clinical characteristics of two groups were similar. The incidence of hypotension and bradycardia in metoprolol group were higher compared with placebo （P≤0.05-0. 01 ）; total mortality （7.8% vs 8.4%）was of no difference （ P= 0. 86 ）. The mean heart rate and BP in metoprolol group were lower than placebo （ P= 0. 01 ）. Conclusion The incidences of hypotension and bradycardia in metoprolol were significantly higher, but no favourable outcomes were found.
出处
《高血压杂志》
CSCD
北大核心
2006年第4期269-273,共5页
Chinese Journal of Hypertension
关键词
美托洛尔
急性心肌梗死
血压
心率
Metoprolol
Acute myocardial infarction
Blood pressure
Heart rate
