摘 要：目的：探讨美托洛尔治疗对扩张型心肌病(DCM)患者心电图QT间期离散度(QTd)及室性心律失常的影响。方法：80例DCM患者分为基础治疗组(A组，40例)及基础治疗加美托洛尔治疗组(B组，40例)，给予B组在基础治疗上加服美托洛尔25mg/tid,疗程9个月。治疗前后应用24h动态心电图和多普勒超声心动图，观测QTd、QTcd、HR、室性心律失常(VA)如室性早搏(PVC)、非持续性室性心动过速(NSVT))的发生情况、左心室射血分数(LVEF)。结果：B组QTd、QTcd及室性心律失常(VA)发生率均较A组显著降低(P均<0.01),左室射血分数(LVEF)较A组明显提高(P<0.01)，而HR、血压无明显变化(P>0.05)。提示B组疗效明显优于A组。结论：DCM患者长期应用美托洛尔可显著降低QTd、QTcd及VA的发生率,改善心功能,改善预后。

    关键词： 美托洛尔； 扩张型心肌病； QT离散度； 室性心律失常

    Study of Metoprolol in Effecting the QTd and Ventricular Arrhythmias in Dilated Cardiomyopathy

    ZHANG Ge-bin， CHEN Bing-zhong

    (Chaoyang People's Hospital of Shantou, Guangdong Shantou 515100, China)

    Abstract： Objective： The aim of the study was to evaluate whether the addition of Metoprolol to conventional therapy in dilated cardiomyopathy(DCM) patients is associated with further benefits in shortening QT intervals dispersions((QTcd) and reducing ventricular arrhythmias(VA). Methods： 80 DCM patients were randomly allocated to two groups (A and B group). A group (conventional therapy group), 40 cases ,with commonly used drugs of cardicglycoside ,diuresis and angiotens inconverting enzyme inhibitor medicine. B group (conventional therapy and Metoprolol group), 40 cases, patients were treated with conventional therapy and Metoprolol 25mg/tid. The course of treatment was 9 months. Before and after the treatment,24 hour Holter was used to monitor HR,VA such as PVC and NSVT, and Doppler ultrasound cardiogram was used to measure left ventricular ejection fraction(LVEF).Results： After 9 month's treatment, LVEF was significantly improved , QTd、QTcd were significantly shortened and VA was markedly reduced in the Metoprolol group compared with that in the conventional therapy group(P<0.05),but there was no significantly difference between the two groups in the HR and the pressure (P>0.05). Conclusions： Metoprolol coupled with commonly used cardiacglycoside, diuresis and ACEI medicine has a better curative effect in shortening QTd、QTcd , reducing ventricular arrhythmias and improving left ventricular function in dilated cardiomyopathy. ......