Metoprolol Combined With Other Drugs In The Treatment Of Ventricular After Myocardial Infarction Clinical Study Of Arrhythmia

Objective:To treat patients with chronic cardiac insufficiency after myocardial infarction with low-dose metoprolol,low-dose metoprolol combined with amiodarone and low-dose metoprolol in combination with mesionic acid.The frequency of arrhythmia,the improvement of heart function index,the total effective rate of heart function,the improvement of QTd and the incidence of adverse reaction,hospital rate,mortality and non-safety event after administration were observed in the 24-hour dynamic electrocardiogram of the patients after different treatment methods.The objective of providing a strong drug-directed medication for clinical treatment has been achieved.Method1?90 cases of chronic cardiac insufficiency after myocardial infarction were randomly treated in our hospital from July 2017 to July 2018.2?Group A?low dose metoprolol combined with amiodarone group?metoprolol tartrate sustaind-release tablets?AstraZeneca Pharmaceutical Co.,Ltd.,traditional Chinese medicine nominal number:J20150044?23.75mg per day,and amiodarone?Hangzhou Sanophee Pharmaceutical Co.,Ltd.,traditional Chinese medicine standard number:H19993254?200 mg twice a day in the first week and 200 mg per day in the second week.3?Group B?low dose metoprolol combined with metoprolol group?metoprolol tartrate sustaind-release tablets?AstraZeneca Pharmaceutical Co.,Ltd.,traditional Chinese medicine nominal number:J20150044?23.75mg per day,and methilol hydrochloric acid?Shanghai Xinyi Pharmaceutical Co.,Ltd.,traditional Chinese medicine reference number:H₃1021874?were taken three times a day 100mg.4?The control group?low dose metoprolol group?metoprolol tartrate sustaind-release tablets?AstraZeneca Pharmaceutical Co.,Ltd.,Chinese medicine quasi-size:J20150044?23.75mg per day,one week after treatment,according to the patient's tolerance to increase the dose as appropriate,the maximum dose is 47.5 mg per day.5?The duration of investigation and treatment in the three groups was 4 weeks.6?Observe the 24h dynamic electrocardiogram of the two groups showed the frequency of arrhythmia attack,the improvement of cardiac function index,the total effective rate of cardiac function treatment,the improvement effect of QTd and the adverse reaction after medication,the hospitalization rate,the mortality rate and the incidence of cardiac unsafe events.Results:1?Before treatment,there was no significant difference in the frequency of ventricular premature beats in group A,group B and control group between group A,group B and control group?P>0.05?.After treatment,the frequency of 24 h dynamic electrocardiogram ventricular premature beats and NSVT in three groups were?3208.61±189.83 and 3057.21±207.31 vs4017.01±179.82?times,?2.05±0.21 and?±0.39 vs 4.71±0.71 ±2.05±0.21 and.0.19 times,compared with group A and group B,the frequency of arrhythmia in group A and group B was significantly lower than that in the control group treated with metoprolol alone?P<0.05?.2?Before treatment,there was no significant difference in NT-proBNP,LVESD,LVEDD,LVEF,SV,HFEI between the three groups,but after treatment,the indexes of NT-proBNP,LVESD,LVEDD,LVEF,SV,HFEI and 6min walking test in the three groups were better than those before treatment,and the indexes of NT-proBNP,LVESD,LVEDD,LVEF,SV,HFEI and 6min walking test in group A and group B were significantly higher than those in the control group?P<0.05?.23±52 ? 435±38 vs475±58 pg/ml,?52.51±6.84 ? 49.31±6,33 vs 49.11±8.98?mm,?33.26±3.38 ? 37.03±4.61 vs36.91±5.39?mm,?57.81±9.22?54.03±10.03 vs 51.89±5.34?%,?72.51±9.31 ? 68.19±7.05 vs 66.91±8?%?.02)ml,?1.79±0.34 and 1.98±0.65 vs 2.43±0.49?,?469.37±185.38 and 437.82±167.28 vs 408.87±191.16?m,compared with the control group,the difference was significant?P<0.05?.3?After treatment,compared with the control group,the effective rates of ventricular premature beats and short array ventricular tachycardia in group A and group B were 83.33%and 86.67%respectively,the difference was significant?P<0.05?.After treatment,compared with the control group,the total effective rate of metoprolol combined with amiodarone in group A was 86.67%,the difference was significant?P<0.05?,but the total effective rate of metoprolol combined with metoprolol in group B was 76.67%,which was not significantly different from that in group B?P>0.05?.4?Before treatment,there was no significant difference in QTd level?QT dispersion?among the three groups,but after treatment,the QTd level of group A and group B was significantly lower than that of the control group,that is,?50.35±4.21 and 48.68±5.07 vs 58.87±4.68?ms,both before and after treatment,the difference was significant?P<0.05?.5?After treatment,the hospitalization rate and the incidence of cardiac unsafe events in group A and group B were significantly lower than those in the control group?13.33 and 20.0 vs 33.33?and?6.67 and6.67 vs15.67?%,respectively.However,compared with the control group,the incidence of adverse reactions in group A and group B was?15.67 and 23.33 vs 6.67?%,which was significantly higher than that in the control group?P<0.05?,but there was no death in the three groups.6?After treatment,tissue A patients have a certain degree of liver injury during the prescribed course of treatment,so it should be helpful to monitor the liver function and protect the liver during the treatment.Conclusion1?The combination of low dose metoprolol and amiodarone,low dose metoprolol and methyclol hydrochloric acid was better than single low dose metoprolol in the treatment of ventricular premature beats after myocardial infarction,and the effect of short array ventricular tachycardia was better than that of single low dose metoprolol in the treatment of ventricular premature beats after myocardial infarction.2?Patients with combination of low-dose metoprolol with amiodarone,and combination of low-dose metoprolol with metoprolol hydrochloride had better QTd shortening than single low-dose metoprolol treatment.3?To summarize the safety of drug use,low dose metoprolol combined with amiodarone,low dose metoprolol combined with methylol hydrochloric acid could effectively control cardiac events and readmission rate,and were significantly lower than those in the control group.4?To summarize the effect of low dose metoprolol combined with amiodarone on improving cardiac function,the therapeutic effect of low dose metoprolol combined with amiodarone was significantly better than that of single low dose metoprolol,but there was no significant difference between low dose metoprolol combined with amiodarone and single low dose metoprolol,but there was no significant difference between low dose metoprolol combined with amiodarone and single low dose metoprolol.