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目的探讨β受体阻滞剂在创伤性休克合并冠心病患者中使用价值及其安全性和必要性。方法回顾性分析郑州市骨科医院自2011年1月—2015年6月118例创伤性休克合并冠心病患者的临床资料,根据临床干预不同,将其随机分为两组:美托洛尔组60例、对照组58例。常规使用Flo Trac/Vigileo心输出量监测系统进行监测分析。以心率、平均动脉压、心指数、每搏输出量、血乳酸的变化值;心律失常、心绞痛、心肌梗塞等不良事件7天发生率作为评价指标。结果美托洛尔组在治疗用药1.5h后心率降低值(△HR)、心电图ST段压低幅度(△ST)及每搏输出量上升幅度(△SV)均大于对照组,差异有统计学意义(P<0.05)。1.5h心指数下降值(△CI),美托洛尔组大于对照组,差异无统计学意义(P>0.05);平均动脉压下降等不良事件无明显增加。美托洛尔组与对照组相比,7d心脏不良事件发生率明显降低,差异有统计学意义(P<0.05)。结论创伤性休克合并冠心病病人早期使用小剂量美托洛尔可显著降低心率,改善心肌缺血,降低恶性心律失常、急性冠脉综合症等心脏不良事件发生率。
Objective To investigate the value and safety and necessity of β-blocker in patients with traumatic shock and coronary heart disease. Methods The clinical data of 118 patients with traumatic shock and coronary heart disease admitted to Zhengzhou Orthopedic Hospital from January 2011 to June 2015 were retrospectively analyzed. According to the clinical intervention, they were randomly divided into two groups: metoprolol group 60 Cases, control group of 58 cases. Traditionally, the Flo Trac / Vigileo cardiac output monitoring system was used for monitoring and analysis. Heart rate, mean arterial pressure, cardiac index, stroke volume, blood lactic acid changes; arrhythmia, angina pectoris, myocardial infarction and other adverse events 7 days incidence as an evaluation index. Results The decrease of heart rate (△ HR), ST segment depression amplitude (△ ST) and stroke volume increase (△ SV) in metoprolol group after 1.5 hours of treatment were both higher than those in control group (P <0.05). 1.5h decreased cardiac index (△ CI), metoprolol group than the control group, the difference was not statistically significant (P> 0.05); mean arterial pressure and other adverse events did not increase significantly. Metoprolol group compared with the control group, 7d cardiac adverse events significantly reduced the incidence, the difference was statistically significant (P <0.05). Conclusion Early use of low dose metoprolol in patients with traumatic shock and coronary heart disease can significantly reduce heart rate, improve myocardial ischemia, and reduce the incidence of cardiac adverse events such as malignant arrhythmia and acute coronary syndrome.