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目的:观察扩张型心肌病(DCM)并发充血性心力衰竭(CHF)患者停止美托洛尔治疗后的临床不良反应。方法:对64例服用美托洛尔≥18个月、心功能Ⅰ～Ⅱ级、无恶性室性心律失常及快速性心律失常的患者进行停药后的临床观察,随访期6个月。结果:7例(10.9%)发生心源性猝死,6例(9.4%)出现快速性室上性心律失常,17例(26.6%)心功能恶化至Ⅲ～Ⅳ级住院治疗;停药前、停药后3个月及6个月时的LVEF为(31.2±3.0)%、(46.3±4.3)%及(38.7±7.6)%。结论:DCM并发CHF的患者服用β受体阻滞剂后停用会出现猝死、心力衰竭恶化、快速性心律失常等不良临床后果,LVEF呈先升高后降低现象,如无停药的指征,DCM并发CHF患者长期甚至终身服用β受体阻滞剂非常必要。
Objective: To observe the clinical adverse effects of Metoprolol in patients with dilated cardiomyopathy (DCM) complicated with congestive heart failure (CHF). Methods: Sixty-four patients undergoing metoprolol ≥ 18 months, Ⅰ ~ Ⅱ cardiac function, non-malignant ventricular arrhythmia and tachyarrhythmia were observed after stopping the drug for 6 months. Results: Sudden cardiac death occurred in 7 patients (10.9%), rapid supraventricular arrhythmias occurred in 6 patients (9.4%), and heart function worsened to grade Ⅲ ~ Ⅳ in 17 patients (26.6% The LVEF at 3 months and 6 months after discontinuation were (31.2 ± 3.0)%, (46.3 ± 4.3)% and (38.7 ± 7.6)%, respectively. CONCLUSIONS: Patients with DCM complicated with CHF who discontinue use of beta-blockers will experience adverse clinical outcomes such as sudden death, worsening heart failure and tachyarrhythmia. LVEF may first increase and then decrease, for example, if there is no indication of discontinuation , DCM complicated with CHF patients long-term or even lifelong use of beta blockers is necessary.