急性ST段抬高性心肌梗死后立即使用螺内酯对左室重构的影响

Effect of immediate administration of spironolactone on left ventricular remodelong after acute myocardial infarction

目的评价醛固酮拮抗剂螺内酯对急性ST段抬高型心肌梗死(STEMI)后左室重构和心功能的影响。方法连续入选160例STEMI患者,随机分为两组。在发病24h内,以目前最佳常规药物治疗做对照组(79例),在常规治疗基础上加用螺内酯做螺内酯组(81例)。两组患者均在STEMI后24h内做多功能超声心动图检查,测定并计算左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)、室壁运动积分指数(WMSI),左室射血分数(LVEF),1月后由专人复查。结果两组基线临床特征及各项超声心动学指标无显著差异,治疗1月后,两组各项超声心动学指标均有明显改善(P<0.05),但螺内酯组各项指标的改善又显著优于对照组(P<0.05)。结论在STEMI发病后常规治疗基础上立即加用螺内酯可进一步加强抗左室重构的作用,进一步改善心脏功能。

AIM To Evaluate the effect of Mineralocortcoit receptor antagonist （MRA） Spironolactone on post-infarct left ventricular remodeling （LVRD）. METHODS One hundred and sixty patients with first anterior AMI were randomly divided into MRA group （n = 81 ） and non-MRA group （n = 79）. All the patients were given agiotensin-converting enzyme inhibitor（ACEI）. The MRA group was treated with Spironolactone combined with routine therapy while the non-MRA group treated only with Spironolactone. Twenty-four hours and 1 month after AMI, left ventricular end diastolic volume Index （LVEDVI）, systolic volume index （LVESVI）, all notion score index （WMSI） and ejection fraction （LVEF） were detected by ultrasonography. RESULTS At basline, no significant difference of ultrasonography indexs was seen between the two groups. At 1 month after treatment, LVEDVI, LVESVI and WMSI significantly decreased （P 〈 0. 05）, whild LVEF increased in both MRA group and non-MRA group （P 〈 0. 05）, but the improvements in MRA group were better than those in non-MRA group （P 〈0. 05）. CONCLUSION Routine therapy combined with MRA can more effectively prevent and treat LVRD in patients with AMI.