小剂量卡维地洛对急性心肌梗死后患者心室重构的影响

Effect of low-dose carvedilol on ventricular remodeling after acute myocardial infarction

目的探讨小剂量卡维地洛(12.5mg/d)对急性心肌梗死后患者心室重构的影响。方法急性心肌梗死患者60例,根据心电图表现将病例分为前壁心肌梗死组(N=42)和下壁心肌梗死组(N=18),均于急性心肌梗死后24-48小时内给予卡维地洛3.125mg×2/日口服,2周后加量为6.25mg×2/日。分别于心肌梗死后1周及25周时记录病人心率、血压,并进行心脏超声检查测量其左心房前后径(LA)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)、左室短轴缩短率(FS)。结果与第1周相比,第25周时病人LA、LVEDD均明显减低(44.22±4.76mmvs39.47±4.45mm;59.53±5.25mmvs53.50±4.28mm,均P<0.001),LVEF、FS明显增加(46.10±6.69%vs56.42±6.14%,P<0.001;9.28±3.32%vs20.79±4·65%,P<0.05)。前壁心肌梗死组病人LVEDD明显大于下壁心肌梗死组(60.57±5.44mmvs57.11±3·92mm,P<0.05),LVEF明显较下壁心肌梗死组低(44.79±6.68%vs49.17±5.77%,P<0.05)。25周时,前壁心肌梗死组病人心室重构改善明显好于下壁心肌梗死组。LVEDD缩小值(6.48±2.74mmvs5.00±2.09mm,P<0.05)、LVEF提高值(10.93±5.15%vs8.89±2.52%,P<0.05),前壁心肌梗死组均较下壁心肌梗死组明显。结论卡维地洛(12.5mg/d)作为靶剂量可明显改善急性心肌梗死后左室重塑,有良好的安全性和耐受性,且对于前壁心肌梗死更为必要和有效。

Objective To investigate the effect of low - dose earvedilol （12.5rag/d） on ventricular remodeling after acute myocardial infarction（AMI）. Methods 60 AMI patients were divided into anterior AMI group and inferior AMI group based on ECG. The dose of 6.25mg/d earvedilol was administrated which would increase to 12. 5mg/d after 2 weeks if it can be tolerated. The heart rate, blood pressure were recorded and the echocardio-graphs were measured to obtain the left atrial diameter（ LA）, left ventrieular end - diastolic diameter（ LVEDD）, left ventrieular ejection fraction（ LVEF）, and left ventrieular shortening fraction（FS）. Results At 25 weeks, patients＇ LA and LVEDD deereased（44.22 ± 4.76mm vs 39.47±4.45mm; 59.53 ± 5.25mm vs 53.50 ± 4.28mm, P〈0.001） and the LVEF and FS increased （46.10 ±6.69% vs 56.42 ±6.14%, P 〈0.001 ; 9.28 ±3.32% vs 20.79 ±4.65%, P 〈0.05 ）. LVEDD was larger in anterior AMI group than that in inferior AMI group （60.57 ± 5.44mm vs 57.11± 3.92mm, P 〈 0.05 ） at 1 week, while LVEF lower （44.79± 6.68% vs 49.17 ± 5.77%, P 〈 0.05 ）. At 25 weeks, the LVEDD of anterior AMI group decreased more than inferior AMI group （6.48 ± 2.74mm vs 5.00 ±2.09mm, P 〈 0.05）, while the LVEF increased more （ 10.93 ± 5.15% vs 8.89 ± 2.52% , P 〈 0.05 ）. Conclusion The dose of carvedilol （12.5mg/d） has the beneficial effect on ventricular remodeling after AMI. It is more necessary and effective for anterior AMI patients.