扩张型心肌病停用β受体阻滞剂后临床观察.doc

扩张型心肌病停用β受体阻滞剂后临床观察 　 作者：陈永东，施德毅，周鱼，孙爱梅，曾其毅，徐永红，吴昌儒 【摘要】 目的观察扩张型心肌病(DCM)并发充血性心力衰竭(CHF)患者停止美托洛尔治疗后的临床不良反应。方法对69例服用美托洛尔≥18个月、心功能Ⅰ～Ⅱ级、无恶性室性心律失常及快速性心律失常的DCM并发CHF患者随机分为治疗组(停用美托洛尔35例)和对照组(不停用美托洛尔34例)。治疗组递减美托洛尔直到完全停服，随访期6个月。结果治疗组心功能恶化和心律失常发生率均明显高于对照组(Plt;0.05或Plt;0.01)。治疗组与对照组相比心率、收缩压、舒张压、LVEF明显增加(P均lt;0.01)。结论DCM并发CHF的患者服用β受体阻滞剂后停用会出现猝死、心力衰竭恶化、快速性心律失常等不良临床后果，如无停药指征，DCM并发CHF患者长期甚至终身服用β受体阻滞剂非常必要。 【关键词】 心肌病，扩张型;心力衰竭，充血性;β受体阻滞剂;美托洛尔 　Abstract:ObjectiveTo observe the clinicaladverse reactions to stoppingbeta-receptor blocker in patients with dilated cardiomyopathy (DCM) associatedwith congestive heart failure (CHF).Methods69patients taking Metoprolol orally for 18 months or over, with NYHA function gra　　des Ⅰ～Ⅱ, with DCM associatedwith CHF and without malignant ventricular arrhythmias and rapid ventricular arrhythmias were assigned to a treated group (35 cases, stopped beta-receptor blocker) and a control group (34 cases, kept taking beta-receptor blocker). The treated group reduced Metoprolol progressively untill completely stopping. A 6-monthfollow-up was performed.ResultsCompared withthe control group, the treated group had higher rates of NYHA function deterioration and cardial arrhythmias (Plt;0.05 or Plt;0.01). Heart rate, systolic pressure, diastolic pressure and LVEF in the treated group also elevated significantly (all Plt;0.01).ConclusionPatients with DCM associated with CHF stopping beta-receptor blocker easily　　induced sudden death, deterioration of heart failure, rapid ventricular arrhythmias, et al. If no stopping drug signs, tt is essential for patients with DCM associated with CHF to take beta-receptor blocker for a long- term even for their lifetime. 　　Key words:cardiomyopathy, dilated; heart failure,congestive; beta-receptor blocker; Metoprolol 　　充血性心力衰竭(CHF)的治疗已有了非常值得注意的转变：从短期血流动力学/药理学措　　施转为长期的、修复性的策略，目的是改变衰竭心脏的生物学性质。近年来，对β受体阻滞　　剂大规模、多中心的研究，使人们对β受体阻滞剂治疗CHF的认识大为改变，β受体阻滞剂　　在CHF中应用获得的益处不仅仅是改善症状、提高生活质量，更重要的是针对心肌重构的机　　制，防止和延缓心肌重构的发展，从而降低心衰的病死率和住院