Effects Of Low Doses Of β₁-blocker On Cerebral-cardiac Syndrome Induced By Acute Cerebral Infarction

Objective:Given low doses of β₁-Blocker in patients within 2 weeks of acute cerebral infarction,and evaluate its efficacy and safety of cerebral heart syndrome associated with cerebral infarction.Materials and methods:From February 2016 to December 2019,we selected 334 patients with acute cerebral infarction in the neurology department of the Fifth Affiliated Hospital of Zhengzhou University,and screened 256 patients for the following reasons:large area cerebral infarction,history of cardiogenic diseases（such as severe bradycardia,atrioventricular block,severe heart failure,etc.）,onset time more than 2 weeks,etc.Finally,78 patients with new acute cerebral infarction were selected.We divided the patients into experimental group and control group according to whether they were given low dose beta blocker（metoprolol）.he control group was treated with conventional therapy:improving circulation（intravascular treatment,intravenous thrombolysis,mechanical thrombectomy,etc.）,reducing blood fat,stabilizing plaque,antiplatelet,.anticoagulation,defibrillation,dilatation,nutritional nerve,etc.,and oxygen inhalation,maintaining circulation and internal environment stability.Experimental group:on the basis of the conventional treatment plan,small dose Betaloc（AstraZeneca Pharmaceutical Co.,Ltd.,Guoyao Zhunzi h32025391）was given,12.5-25mg metoprolol was taken orally once a day for one week.Admitted to hospital after 6 hours to complete the general data collection,including:physical examination,age,gender,medical history,history（including heart disease,diabetes mellitus,hypertension,hyperlipidemia,medical history,history of artery sclerosis,smoking history,drinking history,history of previous stroke history,major surgery history,tumor,etc.）as well as the vital signs after admission（temperature,blood pressure,heart rate,pulse,height,weight,etc.）.Specialist data included:neurological physical examination,National Institute of Health stroke scale（NIHSS）score,etiological classification according to imaging and medical history（TOAST classification）,etc.All patients underwent imaging examination within 24 hours upon admission,including:CT,MRI,MRA or DSA,cardiac color doppler ultrasound,and systemic large blood vessel color doppler ultrasound.ECG was detected,and ECG abnormalities were divided into 5 categories:tachyarrhythmia,bradyarrhythmia,st-t change,Q-T interphase extension,and other abnormalities（u wave,P wave broadening,left ventricular high voltage,left axis deviation）.Blood routine,biochemical and coagulation indexes should be tested.Myocardial injury markers（ck-mb,c-tni）;Hypersensitive c-reactive protein（hs-CRP）;B-type natriuretic peptide（BNP）and other projects need to be detected.Relevant experimental indicators were collected within 24 hours upon admission and 7 days after treatment,including cardiac injury markers（CK-MB,c-TnI）,ECG abnormalities,and hs-CRP.Take CK-MB>25U/L as the critical value,c-tni>0.2μg/L as the critical value,.When above the critical value,the value is considered abnormal.Statistical software SPSS26.0 was used to process and analyze the data.The measurement data were shown as mean±standard deviation（x±s）,and the measurement data were tested by t-test（Student’s t test）.The counting data is expressed as a rate（%）and tested by χ2-test（chi-square test/chi-square Goodness-of-Fit test）.Result:After 1 week of systematic treatment,the incidence and severity of ECG abnormalities（including existing ECG abnormalities at admission and new ECG abnormalities during treatment）in both groups improved（p<0.05）,and the improvement was more significant in the experimental group（p<0.01）.After treatment,the total incidence of abnormal ecg in the experimental group was lower than that in the control group,and the difference was statistically significant（p<0.01）.Before and after treatment,there was no significant difference in the incidence of 5 types of abnormal ECG classification between the groups（p>0.05）.After 7 days of treatment,the indicators of ck-mb and c-TnI in the two groups decreased significantly,and the difference was statistically significant（p<0.01）.Comparison between groups showed that the decrease of myocardial injury markers was more significant in the metoprolol group（p<0.05）.Compared with the hs-CRP index group,there was a significant decrease after treatment（p<0.01）.Compared with the control group,the hs-CRP index of the experimental group decreased more significantly（p<0.01）.Conclusion:（1）The incidence and severity of CCS can be reduced after giving patients in the acute stage of cerebral infarction a low dose of β₁-blocker for 1 week.（2）Beta blockers reduce the risk of CCS by inhibiting enhanced catecholamine release and regulating overactive immune levels.However,the acute stage of cerebral infarction requires the maintenance of appropriate cerebral perfusion pressure,so the timing,dose,and duration of use of β 1-blockers require an accurate individualized regimen.