室壁局部功能测定对靶剂量培哚普利联合美托洛尔治疗急性心肌梗死合并心功能不全疗效评价

Evaluation of curative effect of patients with acute myocardial infarction with left heart insufficiency with Perindopril combined Metoprolol by determination left ventricular regional function

目的:利用实时三维超声心动图(RT-3DE)测量左室16个节段的局部容积-时间曲线(LVRV-TC)及左室节段射血分数-时间曲线(REF-TC)评价靶剂量培哚普利联合美托洛尔治疗急性心肌梗死(AMI)合并左心功能不全患者的临床疗效。方法:46例AMI合并左心功能不全患者随机分为对照组和治疗组,随访半年,观察两组治疗前后RT-3DE左室射血分数(RLVEF),LVRV-TC指标包括局部舒张末期容积(REDV)、收缩末期容积(RESV)以及REF-TC值的变化。其中,对照组给予AMI常规治疗,包括阿司匹林和(或)氯吡格雷、他汀类药、硝酸酯类药,常规剂量的美托洛尔(25 mg,每日2次)、培哚普利(2～4 mg,每日1次)及曲美他嗪等;治疗组在对照组的基础上使用靶剂量的培哚普利8 mg/d、美托洛尔200 mg/d或达最大耐受剂量。结果:两组患者治疗前一般资料比较,差异无统计学意义(P>0.05);两组治疗后RLVEF、REF与治疗前比较,差异有统计学意义(P<0.05,P<0.01);对照组和治疗组治疗后REF组间比较差异有统计学意义(P<0.05);治疗过程中两组不良反应差异无统计学意义(P<0.05)。结论:靶剂量的培哚普利联合美托洛尔治疗对AMI合并左心功能不全患者受损节段心肌重构效果较常规剂量更好。

Objective： To evaluate the curative effect of left ventricular regional function of the patients with acute myocardial infarction with left heart insufficiency with Perindopril combined Metoprolol by real-time three-dimensional echocardiography（RT-3DE）.Methods： 46 AMI patients with left heart insufficiency were divided into control group and treatment group randomly and followed up for six months,three-dimensional image data were acquired analyzed offline.Regional volume curves and regional ejection fraction curves were derived.Regional diastolic volumes,regional systolic volumes and regional ejection fractions were compared respectively between two groups.Control group received conventional AMI therapy,including Aspirin and（or） Clopidogrel,Statins,Nitrates,conventional doses of Metoprolol（25 mg,2 times a day）,Perindopril（2-4 mg,1 time a day） and Trimetazidine,et al;the treatment group used of the target dose of Perindopril 8 mg/d,Metoprolol 200 mg/d or up to Maximum tolerated dose on the basis of control group.Results： The general information had no significant difference between the two groups before the treatment（P0.05）;the RLVEF,REF of two groups had significant difference before and after treatment（P0.05,P0.01）;the differences of REF between two groups after treatment was significantly statistical（P0.05）;the adverse events between of groups had no significant difference（P0.05）.Conclusion： The target dose of Perindopril combined Metoprolol are beneficial to the left ventricular remodeling of infracted segments in the patients with AMI with left heart insufficiency.