目的 探讨大剂量西地兰联合小剂量酒石酸美托洛尔经静脉途径治疗急性左心衰伴快速心室率心房颤动的疗效与安全性。 方法 将2005年6月－2012年2月收治的76例急性左心衰伴快速心室率心房颤动患者，随机分配至对照组（39例）与治疗组（37例），对照组静脉注射西地兰，治疗组静脉注射西地兰与小剂量酒石酸美托洛尔，分别在用药开始时及用药开始后全程监测收缩压、心室率、呼吸频率、手指脉搏血氧饱和度（SpO2）、呼吸困难程度、肺部啰音与治疗2 h时尿量，记录急性左心衰改善时间。 结果 两组患者在治疗开始时心室率（P=0.246）、呼吸频率（P=0.390）、收缩压（P=0.525）与SpO2（P=0.482）均无统计学意义；在治疗整个过程中，两组患者收缩压与治疗2 h尿量均无统计学意义（P=0.264）；在治疗开始后30、60、90、120 min时治疗组患者心室率均显著低于对照组（P=0.000）。治疗组患者从在治疗开始到急性左心衰改善的时间明显短于对照组（P=0.003）。试验期间无1例患者出现病情恶化或死亡。 结论 在排除美托洛尔禁忌症的前提下，在严密监测肺部啰音及指氧饱和度的情况下，对那些平时心功能Ⅰ~Ⅱ级的急性左心衰伴快速心室率心房颤动患者，在经静脉途径给予大剂量西地兰的同时，间断多次静脉注射小剂量美托洛尔，能安全有效地控制过快心室率，缩短急性左心衰竭持续时间。
【摘要】 目的 探讨西地兰联合小剂量酒石酸美托洛尔静脉注射治疗二尖瓣狭窄合并急性肺水肿与快速型心房颤动的疗效与安全性。 方法 将2005年1月-2010年2月收治的60例二尖瓣狭窄合并急性肺水肿与快速型心房颤动患者，随机分配至西地兰组与联合用药组，西地兰组以多次静脉注射西地兰控制心率，联合用药组则予以多次静脉注射西地兰与小剂量酒石酸美托洛尔，分别在用药开始时、用药开始后监测收缩压、心率、呼吸频率与手指脉搏血氧饱和度（SpO2），同时观察肺部啰音、呼吸困难，记录肺水肿改善时间。 结果 两组患者在治疗开始时心异率、呼吸频率、收缩压与SpO2均无差异；在治疗整个过程中，两组患者收缩压无差异；治疗开始后60、90及120 min时联合用药组心率均显著低于西地兰组。联合用药组从在治疗开始到肺水肿改善的时间短于西地兰组[(71.37±13.37)、(78.77±14.74) min，P=0.046]。治疗期间无患者出现病情恶化或死亡。联合用药组患者的酒石酸美托洛尔平均总量为4.22 mg/例。 结论 在排除美托洛尔禁忌症的前提下，静脉注射西地兰与小剂量酒石酸美托洛尔可快速、安全、有效地控制二尖瓣狭窄合并急性肺水肿与心房颤动患者的心率，缓解肺水肿。【Abstract】 Objective To observe the effect of intravenous injection with cedilanid and small does of metoprolol tartrate on mitral stenosis complicating with acute pulmonary edema and atrial fibrillation. Methods Sixty patients with mitral stenosis complicating with acute pulmonary edema and atrial fibrillation from January 2005 to February 2010 were randomly divided into cedilanid group and drug combination group, which was administered with cedilanid, or cedilanid and small does metoprolol tartrate by intravenous injection, respectively. Systolic blood pressure, heart rate, respiratory rate, pulse oxygen saturation (SpO2), dypnea, rales over lung field and the time from beginning of treatment to pulmonary edema improved were monitored as soon as the treatment began. Results There was no significant difference in basic data such as systolic blood pressure, heart rate, respiratory rate and SpO2 at the beginning of treatment between the two groups, and no obvious difference was seen in systolic blood pressure at all the time of treatment between the two groups; while a obvious decrease took place in heart rate between cedilanid group and drug combination group after the treatment began; the time from beginning of treatment to pulmonary edema in drug combination group was much shorter than that in cedilanid group [(71.37±13.37), (78.77±14.74) minutes, P=0.046]. Conclusion Without contraindication of metoprolol, intravenous injection with cedilanid combined with small dose of metoprolol can effectively, quickly and safely treat the patients with mitral stenosis complicating with acute pulmonary edema and atrial fibrillation by controlling the heart rate.