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目的研究不同类型的β受体阻滞剂对心脏自主神经功能的影响。方法选择因心电图表现为ST-T改变而行普奈洛尔试验的患者,根据随机、配对原则,将患者分为Ⅰ组:普奈洛尔组;Ⅱ组:阿替洛尔组和Ⅲ组:美多洛尔组。所有患者均无器质性心脏病。试验开始时描记平卧5min后的常规12导联心电图后,分别顿服普奈洛尔20mg、阿替洛尔25mg、美多洛尔50mg,然后描记服药后1h、2h的平卧5min后的常规12导联心电图,并观察患者的心率变化情况。并与心电图同步采集患者服药前、服药后1h、2h连续520次的正常RR间期,分析RR间期标准差(SD)、RR间期标准差均值(MSD)、RR间期均方根差(MSSD)、相邻两个正常心动周期差值大于50ms的个数所占的百分比(PNN50)、变异系数指数(HRVI)以及低频/高频比值(LF/HF)的变化情况。结果三类β受体阻滞剂均可以明显升高SD、MSD、MSSD、PNN50及HRVI,降低LF/HF(p<0.01),其中美多洛尔升高SD、MSD、MSSD、PNN50、HRVI及降低LF/HF更为明显(p<0.01),且服药后2h仍有明显的影响(p<0.01)。同时,三类β受体阻滞剂均可以减慢心率,但心率的降低没有明显的差异(p>0.05),而美多洛尔心率下降相比幅度要小。结论β受体阻滞剂具有抑制交感神经张力,拮抗过度激活的交感神经系统,保护心脏的作用,而脂溶性高选择性β受体阻滞剂美多洛尔对心脏自主神经功能具有更为显著的改善作用,且安全性较好,更具有显著的心脏保护作用。
Objective To study the effects of different types of β-blockers on cardiac autonomic nervous system function. Methods Patients who received propofol for ECG changes due to ST-T changes were divided into group Ⅰ: propranolol group, group Ⅱ: atenolol group and group Ⅲ according to the principle of randomization and pairing. : Meddorol Group. All patients had no organic heart disease. At the beginning of the experiment, the routine 12-lead electrocardiogram after 5min of supine was recorded and then treated with propranolol 20mg, atenolol 25mg and metoprolol 50mg, respectively, and then traced 1h after treatment and 5h after 2h of supine Conventional 12-lead ECG, and observe changes in the patient’s heart rate. The patients were followed up simultaneously with the electrocardiogram (ECG). The RR interval standard deviation (SD), RR interval standard deviation (MSD), RR interval root mean square error (MSSD), the percentage of the number of the two adjacent normal cardiac cycles> 50ms (PNN50), coefficient of variation (HRVI) and low frequency / high frequency ratio (LF / HF) Results All three kinds of β-blockers could significantly increase SD, MSD, MSSD, PNN50 and HRVI and reduce LF / HF (p <0.01). Metoprolol increased SD, MSD, MSSD, PNN50, HRVI And lower LF / HF (p <0.01), and still had a significant effect at 2 hours (p <0.01). At the same time, all three types of beta-blockers slowed heart rate, but there was no significant difference in heart rate reduction (p> 0.05), whereas heart rate in Metoprolol decreased less. Conclusion β-blockers can inhibit the sympathetic tone, antagonize the over-activation of the sympathetic nervous system, protect the heart, and the fat-soluble high selective β-blocker, metoprolol, has more autonomic nerve function Significant improvement, and better safety, more significant role in cardioprotection.