本文選題：心肌梗死　切入點：慢性心功能不全　出處：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的通過臨床試驗研究探索小劑量倍他樂克聯(lián)合胺碘酮、小劑量倍他樂克聯(lián)合美西律與單一使用倍他樂克對心肌梗死后慢性心功能不全并非持續(xù)性室性心律失常的患者的療效對比,探討最佳治療方案,指導(dǎo)臨床用藥。方法本研究選取于心內(nèi)科就診的心肌梗死后慢性心功能不全并非持續(xù)性室性心律失常的患者共96例,隨機分3組,在積極治療心肌梗死后慢性心功能不全基礎(chǔ)上,小劑量倍他樂克聯(lián)合胺碘酮組(A組)給予倍他樂克12.5mg/次,2次/d,并加用鹽酸胺碘酮片:第一周,200mg/次,2次/d,口服;自第二周起,每次劑量不變,用藥次數(shù)改為1次/d。小劑量倍他樂克聯(lián)合美西律組(B組)給予倍他樂克12.5mg/次,2次/d,并加用鹽酸美西律片100mg/次,3次/d。對照組(C組)給予倍他樂克12.5mg/次,2次/d,1周后根據(jù)患者耐受情況可最大加量至25mg/次,2次/d。三組均治療4周為一個療程。觀察記錄受試者用藥前后的24小時動態(tài)心電圖、超聲心動圖,記錄其早搏及短陣室速次數(shù)變化及心功能變化、實驗前后QT離散度(QT dispersion,QTd)變化、用藥后相關(guān)不良反應(yīng)等。結(jié)果1.小劑量倍他樂克聯(lián)合胺碘酮、小劑量倍他樂克聯(lián)合美西律在減少室性早搏、短陣室速方面的有效率(84.38%、83.50%)均顯著高于單一用藥組(59.38%)(P0.05)。2.三組患者用藥后心功能各項指標(biāo)均較各組用藥前好轉(zhuǎn)(P0.05);小劑量倍他樂克聯(lián)合胺碘酮組NT-proBNP、左心功能、心衰超聲指數(shù)等指標(biāo)的改善明顯優(yōu)于單一用藥組(P0.05)。小劑量倍他樂克聯(lián)合胺碘酮在改善心功能方面效果明顯優(yōu)于單一用藥組(P0.05),但小劑量倍他樂克聯(lián)合美西律組在改善心功能方面較單一用藥物組無明顯優(yōu)勢(P0.05)。3.治療后三組的QTd水平均顯著小于本組治療前(P0.05),且兩個聯(lián)合用藥組QTd水平均顯著小于對照組(P0.05)。4.兩藥物聯(lián)用組住院率及心臟事件發(fā)生率明顯少于對照組(P0.05)。三組用藥均發(fā)生不同程度的不良反應(yīng)。小劑量倍他樂克聯(lián)合胺碘酮肝損傷的不良反應(yīng)較為明顯。結(jié)論1.小劑量倍他樂克聯(lián)合胺碘酮、小劑量倍他樂克聯(lián)合美西律在減少室性早搏、減少短陣室速發(fā)作次數(shù)上療效優(yōu)于單一使用倍他樂克;同時兩組聯(lián)合用藥組患者的QTd水平較對照組明顯減小;兩組聯(lián)合用藥組患者的心臟事件及再住院率明顯低于對照組。2.小劑量倍他樂克聯(lián)合胺碘酮在改善心功能方面優(yōu)于單一使用倍他樂克;但小劑量倍他樂克聯(lián)合美西律在改善心功能方面較單一使用倍他樂克無明顯優(yōu)勢。倍他樂克聯(lián)合胺碘酮用藥時產(chǎn)生的肝損傷發(fā)生率較高。
[Abstract]:Objective to explore small dose Betaloc combined with amiodarone through clinical trials, small dose Betaloc combined with mexiletine and single use Betaloc curative effect on myocardial infarction after chronic heart failure is not sustained ventricular arrhythmias in patients, to explore the best treatment method of the clinical medication. Study on Department of Cardiology in our hospital after myocardial infarction, chronic heart failure is not sustained ventricular arrhythmias in patients with a total of 96 cases were randomly divided into 3 groups, in the active treatment after myocardial infarction and chronic heart failure on the basis of small dose Betaloc combined with amiodarone group (A group) was given Betaloc 12.5mg/, 2 /d, and with Amiodarone Hydrochloride Tablets: the first week, 200mg/ times, 2 times /d, oral; since the second week, each dose of medication is unchanged, 1 /d. of low dose Betaloc combined with mexiletine group (B group) was given Betaloc 12 .5mg/, 2 /d, and with Mexiletine Hydrochloride Tablets 100mg/, the 3 /d. control group (group C) was given Betaloc 12.5mg/ times, 2 times /d, 1 weeks according to the patients tolerated the maximum dosage to 25mg/ times, 2 times /d., three groups were treated for 4 weeks as a course. Observe and record the subjects' dynamic ECG 24 hours before and after the treatment, echocardiography, cardiac function and the change of record number of beats and paroxysmal ventricular tachycardia, before and after the experiment of QT dispersion (QT dispersion, QTd) changes after medication related adverse reactions. Results 1. small dose Betaloc combined with amiodarone, small the dose of Betaloc combined with mexiletine in reducing ventricular premature beats, paroxysmal ventricular tachycardia in terms of efficiency (84.38%, 83.50%) were significantly higher than that of single drug group (59.38%) (P0.05).2. of the three groups of patients after heart function indexes were lower than before treatment were improved (P0.05); low dose of times he metoprolol combined with amiodarone group NT-proBNP And the left ventricular function improved significantly better than the single drug group of heart failure echocardiography index (P0.05). The small dose Betaloc combined with amiodarone in improving heart function was better than the single drug group (P0.05), but a small dose of Betaloc combined with mexiletine group in improving heart function than single drug no obvious advantage (P0.05).3. QTd the three groups after treatment were significantly less than before treatment in treatment group (P0.05), and the two combination therapy group QTd levels were significantly lower than the control group (P0.05).4. two drug group hospitalization rate and incidence of cardiac events was significantly less than the control group (P0.05 three). Group had different degrees of adverse reactions. Small dose of metoprolol combined with amiodarone adverse reaction grams liver injury obviously. Conclusion 1. small dose Betaloc combined with low-dose amiodarone and Betaloc combined with mexiletine in reducing ventricular premature beat, reduce short array Ventricular tachycardia episodes on curative effect than single use of Betaloc; while two group combination group of patients with QTd levels than the control group obviously decreased; the two group combination group of patients with cardiac events and readmission rate was significantly lower than the control group.2. low-dose Betaloc combined with amiodarone is better than the single use of Betaloc in on the improvement of cardiac function; but a small dose of Betaloc combined with mexiletine in improving heart function than the single use of Betaloc. Liver injury produced no obvious advantage of Betaloc combined with amiodarone treatment had a higher incidence.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541;R542.22

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