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目的：探讨美托洛尔（ｍｅｔｏｐｒｏｌｏｌ）治疗充血性心力衰竭（ＣＨＦ）的有效性和可行性。方法：采用随机对照方法，观察经强心、利尿和血管紧张素转换酶抑制剂（ＡＣＥＩ）治疗仍有ＣＨＦ症状的扩张型心肌病患者加用美托洛尔治疗前后循环内分泌因子和心功能状态的变化。结果：①治疗３个月时，美托洛尔组心胸比和心脏面积与对照组相比均明显缩小（分别Ｐ＜００１）；②治疗３个月时，美托洛尔组左室射血分数（ＬＶＥＦ）较对照组显著增高（３７３５±６２８ｖｓ３３２５±６４６，Ｐ＜００１）；③所有患者血浆内皮素（ＥＴ）和去甲肾上腺素（ＮＥ）水平均与ＬＶＥＦ呈负相关（均Ｐ＜０００１）；④显效组患者年龄偏小，心率偏快，血浆ＮＥ，ＥＴ水平较高，和其他组相比有显著差异。结论：美托洛尔治疗ＣＨＦ有效，尤其年龄偏小、心率偏快、血浆ＮＥ和ＥＴ水平较高的扩张型心肌病亚组。
Objective: To investigate the efficacy and feasibility of metoprolol in the treatment of congestive heart failure (CHF). Methods: A randomized controlled trial was conducted to observe the effects of metoprolol on endocrine factors and cardiac function in patients with dilated cardiomyopathy who still had symptoms of CHF by cardiac, diuretic and angiotensin converting enzyme inhibitor (ACEI) The change. Results: ① At 3 months, the cardiothoracic ratio and heart area in metoprolol group were significantly reduced compared with those in control group (P <001, respectively); ② At 3 months, the left ventricular The ejection fraction (LVEF) was significantly higher than that of the control group (3735 ± 628 vs 3325 ± 646, P <001). ③The plasma endothelin (ET) and norepinephrine (NE) (P <0001); ④ The patients in the effective group were younger, had faster heart rate and higher levels of NE and ET in plasma, which were significantly different from those in other groups. Conclusion: Metoprolol is effective in treating CHF, especially in the subgroup of dilated cardiomyopathy with younger age, faster heart rate and higher levels of plasma NE and ET.