静脉注射硝酸酯类对急性心肌梗死早期左心室舒张功能的影响

Effects of the left ventricular diastolic function of intravenous nitroglycerin and isosorbide dinitrate in early stage of acute myocardial infarction

目的观察硝酸甘油(NTG)及二硝基山梨醇酯(IDN)在急性心肌梗死(AMI)患者对左心室舒张功能的疗效。方法根据超声心动图二尖瓣血流频谱将AMI患者28例分为3组:2>E/A>1(A组);E/A<1(B组);E/A>3(C组)。用二尖瓣和肺静脉血流频谱作为观察指标。结果二尖瓣:静注NTG或IDN后,C组可显著降低E/A比值及E峰下降速率(均P<0.05);而A,B2组患者对上述参数均无影响;肺静脉:静注IDN后,3组均可使肺静脉血流频谱S/D比值显著升高(均P<0.05),Ar负向峰值速率显著下降(均P<0.05);但NTG对这2项参数无明显影响。结论在AMI早期,静脉注射硝酸甘油和二硝基山梨醇酯均可改善左心室舒张功能。

ObjectiveTo compare the effect of intravenous nitroglycerin and isosorbide dinitrate (Isoket ) used in acute phase of myocardial infarction on Doppler transmitral and pulmonary venous flow patterns. Methods Doppler transmitral and pulmonary venous flow patterns were adopted as parameters to evaluate diastolic function of the left ventricule. According to transmitral flow patterns, 28 patients were assigned to three groups. Group A (n=10) were with normal Doppler transmitral flow pattern (2>E/A>1), while group B (n=10) were with transmitral flow pattern of E/A<1 and group C (n=8), E/A>3. A double blind and cross-over method was used for every patient to receive both of nitrates. Results In patients with Doppler transmitral flow patterns E/A>3, intravenous nitroglycerin and isosorbide dinitrate decreased E/A ratio (P<0.05) and E wave peak velocity (P<0.05) significantly, while these changes were not observed in patients with normal or E/A<1 transmitral Doppler patterns. In patients with acute myocardial infarction, both nitroglycerin and isosorbide dinitrate increased S/D ratio (P< 0.05) and decreased Ar wave peak velocity (P<0.05) of pulmonary venous Doppler flow patterns significantly. Conclusion Intravenous nitrates can improve left ventricular diastolic function in early stage of acute myocardial infarction, which is most pronounced in the group with restrictive diastolic disfunction (E/A>3). Compared with Doppler transmitral flow patterns, pulmonary venous flow patterns might be more sensitive in evaluating left ventricular diastolic function and its dynamic changes.