Analysis Of Drug Therapy In Patients With Chronic Cardiac Insufficiency And Nonsustained Ventricular Arrhythmia After Myocardial Infarction

ObjectiveTo explore and compare the curative effect of treatment of the patients with Chronic Cardiac Insufficiency and Nonsustained Ventricular Arrhythmia after Myocardial Infarction by a combination of small-dose metoprolol tablets with amiodarone,by a combination of small-dose metoprolol tablets with mexiletine and by metoprolol tablets alone through clinical test,and to explore the optimal therapeutic program and guide the clinical medication.MethodsThis study selected a total of 96 cases of patient with Chronic Cardiac Insufficiency and Nonsustained Ventricular Arrhythmia after Myocardial Infarction who were admitted to the department of cardiology and divided them into 3 groups randomly,based on an active treatment of post-myocardial infarction chronic cardiac insufficiency,the patients in small-dose metoprolol tablets combined with amiodarone group(group A)were administered with metoprolol tablets by 12.5mg/time,twice a day,coupled with an administration of amiodarone hydrochloride tablet: 200mg/time for the first week,twice a day,orally;since the 2nd week,the frequency of medication has been changed to once a day without changing the dosage per time.The patients in small-dose metoprolol tablets combined with mexiletine group(group B)were administered with metoprolol tablets by 12.5mg/time,twice a day,coupled with an administration of mexiletine hydrochloride tablet by 100 mg per time,three times a day.The patients in control group(group C)were administered with metoprolol tablets by 12.5mg/time,twice a day.And the dosage was increased to 25 mg after a week according to the patient tolerance,once a day.The dynamic ECG of subjects 24 hours and Echocardiography before and after the medication was observed and recorded,the change in frequency of ventricular premature beat and nonsustained ventricular tachycardia,cardiac function,QTd before and after test,blood pressure before and after test and relevant adverse reactions after medication were recorded.Results1.Both of the small-dose metoprolol tablets combined with amiodarone group and small-dose metoprolol tablets combined with mexiletine group had a significantly higher effective rate(84.38% ? 83.50%)of reduction of ventricular premature beat and nonsustained ventricular tachycardia than the control group did(59.38%)(P<0.05).2.After treatment,the cardiac function indicators of the three groups of patients were better than before((P<0.05).The indexes of NT-proBNP,left heart function and heart failure ultrasound index were better than those of single administration group(P<0.05).The small-dose metoprolol tablets combined with amiodarone group was better than the control group in improving the cardiac function(P<0.05).But small-dose metoprolol tablets combined with mexiletine group was not significantly superior to the control group in improving the cardiac function(P>0.05).3.The post-therapy level of QTd of three groups were all significantly lower than their pre-therapy level(P<0.05),and the QTd level of two combined medication groups was both significantly lower than that of the control group(P<0.05).4.The two combined medication groups had a significantly lower rate of hospitalization and cardiac events than the control group did(P<0.05).Adverse reactions of varying degrees happened in all the three groups.The small-dose metoprolol tablets combined with amiodarone group had markedly more adverse reactions of liver injury.Conclusion1.The small-dose metoprolol tablets combined with amiodarone and small-dose metoprolol tablets combined with mexiletine have a better curative effect than the metoprolol tablets alone did in reducing the frequency of onset of ventricular premature beat and nonsustained ventricular tachycardia;meanwhile,the level of QTd of patients in two combined medication groups were significantly reduced as compared to the control group;the patients in two combined medication groups had a significantly lower rate of hospitalization and cardiac events than the ones in control group.2.The small-dose metoprolol tablets combined with amiodarone is better than metoprolol tablets alone in improving the cardiac function;but small-dose metoprolol tablets combined with mexiletine group was not significantly superior to the control group in improving the cardiac function.The small-dose metoprolol tablets combined with amiodarone had a higher rate of liver injury during medication.