小剂量卡托普利对急性心肌梗死后远期治疗价值

Beneficial Effects of Long-term Therapy With Captopril After Acute Myocardial Infarction

目的：为了探讨血管紧张素转化酶抑制剂（ＡＣＥＩ）对急性心肌梗死（ＡＭＩ）后的抗缺血作用和对左心室结构的远期影响。方法：１１０例ＡＭＩ患者于发病后７天随机分为卡托普利（１２．５ｍｇ，每日２次）和对照组，定期检查超声心动图、动态心电图及单光子发射计算机体层摄影（ＳＰＥＣＴ），随访观察１年（ｎ＝１０２）。结果：卡托普利组（ｎ＝５１）心肌缺血负荷从发病７天至６个月呈进行性减低。１年后卡托普利组核素缺损面积缩小（Ｐ＜０．０１），节段射血分数明显增加（Ｐ＜０．００１），与对照组（ｎ＝５１）比较有显著性差异（Ｐ＜０．０１，Ｐ＜０．００１）。对照组Ｑ波型心肌梗死左心室收缩末期和舒张末期容量指数均呈进行性增加，卡托普利组舒张末期容量指数轻度增加（Ｐ＜０．０５），而收缩末期容量指数则明显降低（Ｐ＜０．０１）。相关分析表明，Ｑ波型心肌梗死心室容量变化与心肌缺血总负荷之间呈正相关（ｒ＝０．８１，Ｐ＜０．０１）。结论：卡托普利对ＡＭＩ后６个月内左心室的明显扩张，有显著抑制作用。其抗缺血作用机制及可能对梗死周围存活心肌的作用有待进一步研究。Ｐ＜０．００１２４小时动态心电图对心肌缺血负荷观察表明，卡托普利组从发病第７天至６个月间心肌缺血?

Objective: To study the long-term anti-ischemic and left ventricular dilation effects of angiotensin converting enzyme inhibitors in patients with acute myocardial infarction(AMI). Methods:One hundred and ten patients with AMI were randomized on day 7 after onset of MI to either placebo or captopril(12.5 mg twice daily)group and followed up for a period of 1 year(n=51 in each group)by serial echocardiography,ambulatory ECG monitoring, and single-photon emission computed tomography(SPECT).Results:The myocardial ischemic burden was significantly reduced in the captopril group from day 7 to 6 month. The perfusion defect area of SPECT was reduced,the infarct regional wall ejection fraction was increased during the period of 1 year follow up with significant differences as compared with the corresponding control group(p<0.01 and p<0.001,respectively). Furthermore, in Q-wave infarction the increases of left ventricular end-diastolic and end-systolic volume indexes were observed in the placebo group,this was prevented in the captopril group,where,in addition,a significant reduction in end-systolic volume index was observed (p<0.001),In the Q-wave group there was a positive correlation between the percentage changes in left ventricular volume and myocardial ischemic burden(r=0.81,p<0.01).Conclusion: The results indicate a significant effect of captopril to prevent left ventricular dilation occurred within 6 month after Q-wave infarction. It is suggested that the anti-ischemic mechanism and the beneficial effect of captopril on the viable myocardium need further clarification.