依那普利、美托洛尔预防蒽环类药物心脏毒性所致心律失常的临床研究

陈存茂 唐方明 江珠 陈冠鹏 莫淑芬 苏鑫儒

【摘要】 目的：探讨依那普利、美托洛尔预防蒽环类药物心脏毒性所致心律失常的临床效果。方法：选择2018年1月-2019年6月本院收治的160例乳腺癌患者为研究对象。利用随机数字表法将其分为对照组（常规营养心肌）、研究1组（依那普利）、研究2组（美托洛尔）以及研究3组（依那普利+美托洛尔），各40例。记录并比较各组患者第2、4、6个疗程末发生心律失常、心电图异常及心肌酶谱异常的情况，比较各组临床治疗效果。结果：第4、6个疗程末，各研究组频发性室性早搏、成对室性早搏、短阵室性心动过速的发生率均低于对照组，且研究3组频发性室性早搏、成对室性早搏、短阵室性心动过速的发生率均低于研究1组和研究2组，差异均有统计学意义（P<0.05）。第4、6个疗程末，各研究组ST-T段改變、P-R间期延长发生率均低于对照组，且研究3组心电图ST-T段改变、P-R间期延长发生率低于研究1组和研究2组，差异均有统计学意义（P<0.05）。第4、6个疗程末，各研究组的CK、CK-MB指标异常发生率均低于对照组，且研究3组的CK、CK-MB指标异常发生率低于研究1组和研究2组，差异均有统计学意义（P<0.05）。各研究组的临床总有效率均高于对照组，差异均有统计学意义（P<0.05）;研究3组的临床总有效率高于研究1组和研究2组，差异均有统计学意义（P<0.05）;研究

1组与研究2组的临床总有效率比较，差异无统计学意义（P>0.05）。结论：对于蒽环类药物心脏毒性所致心律失常，依那普利、美托洛尔均可降低心律失常及心肌损伤风险，但两者联合治疗的效果更为理想。

【关键词】 蒽环类 心律失常 依那普利 美托洛尔

Clinical Study of Enalapril and Metoprolol in the Prevention of Arrhythmia Caused by Cardiotoxicity of Anthracycline Drugs/CHEN Cunmao， TANG Fangming， JIANG Zhu， CHEN Guanpeng， MO Shufen， SU Xinru. //Medical Innovation of China， 2020， 17（11）： 031-036

[Abstract] Objective： To investigate the efficacy of Enalapril and Metoprolol in the prevention and treatment of arrhythmia caused by cardiotoxicity of anthracycline drugs. Method： A total of 160 breast cancer patients admitted to our hospital from January 2018 to June 2019 were selected as the study subjects. They were divided into control group （conventional trophic myocardium）， study group 1 （Enalapril）， study group 2 （Metoprolol） and study group 3 （Enalapril + Metoprolol） according to the drugs used， 40 cases in each group. The occurrence of arrhythmia， abnormal electrocardiogram and abnormal myocardial enzyme spectrum at the end of the 2， 4 and 6 course of treatment in each group was recorded and compared. The clinical therapeutic effects of the two groups were compared. Result： At the end of treatment 4 and 6， the incidence rates of frequent ventricular premature beats， paired ventricular premature beats and short array ventricular tachycardia in each study group were all lower than those in the control group， and the incidence rates of frequent ventricular premature beats， paired ventricular premature beats and short array ventricular tachycardia in study group 3 were lower than those in study group 1 and study group 2， the differences were statistically significant （P<0.05）. At the end of treatment 4 and 6， the incidence of ST-T segment changes and P-R interphase prolongation were lower in each study group than those in the control group， and the incidence of ST-T segment changes and P-R interphase prolongation in study group 3 were lower than those in study group 1 and study group 2， the differences were statistically significant （P<0.05）. At the end of treatment 4 and 6， the abnormal incidence of CK and CK-MB indexes in each study group were lower than those in the control group， and the abnormal incidence rate of CK and CK-MB in study group 3 were lower than those in study group 1 and study group 2， the differences were statistically significant （P<0.05）. The total clinical efficiency of each study group were higher than those of the control group， the differences were statistically significant （P<0.05）. The total clinical efficiency of study group 3 was higher than those of study group 1 and study group 2， the differences were statistically significant （P<0.05）. The total clinical efficiency of study group 1 and study group 2 was compared， the difference was not statistically significant （P>0.05）. Conclusion： For arrhythmias caused by cardiac toxicity of anthracyclines， both Enalapril and Metoprolol can reduce the risk of arrhythmia and myocardial injury， but the combination of them is more effective.

[Key words] Anthracycline Arrhythmias Enalapril Metoprolol

First-authors address： Zhanjiang Agricultural Reclamation Second Hospital， Zhanjiang 524272， China

doi：10.3969/j.issn.1674-4985.2020.11.008

目前，蒽環类抗肿瘤药，如表柔比星、吡柔比星等是抗乳腺癌化疗方案中经典细胞毒类药物，可使部分乳腺癌患者长期生存率增至70%以上[1]。但由于此类药物具有潜在心脏毒性，患者在化疗后可发生不同程度心肌损伤、心律失常症状，严重限制其临床应用[2-3]。依那普利为ACEI类药物，通过降低血管紧张素Ⅱ的生成，减轻心脏后负荷以达到心脏保护的目的[4-5]。美托洛尔为β受体阻滞剂，可以降低心率及异位起搏点频率，消除心室壁异常节段收缩功能，因此具有较好的抗心律失常作用[6-7]。本……