血管紧张素转换酶抑制剂治疗急性心肌梗死合并心房颤动效果观察

Therapeutic effect of angiotensin converting enzyme inhibitor on acute myocardial infarction with atrial fibrillation

目的评价血管紧张素转换酶抑制剂（ACEI）治疗急性心肌梗死（AMI）合并心房颤动（AF）的治疗效果。方法回顾性分析2005年1月~2015年7月于武汉大学人民医院就诊的急性心肌梗死合并心房颤动患者28 000例临床资料。按照入院顺序将AMI合并AF患者随机分为A、B两组,每组14 000例。A组患者在胺碘酮基础上联用ACEI类药物,起始剂量4mg/次、1次/d;B组患者予胺碘酮,首剂150mg静脉推注,偶发心房颤动者口服维持,200mg/次、1次/d。观察两组患者的超声心动图变化,AF转复情况,统计住院时间及院内死亡率等。采用SPSS 13.0软件,计量资料采用t检验,计数资料采用χ2检验,P〈0.05为差异有统计学意义。结果 24周后,A组LVMWg、LVEDV、LVESV、LVEF、E峰、A峰、E/A、WMSI均较治疗后1周有进步,均优于B组,差异均有统计学意义（P〈0.05）;B组LVMWg、LVEDV、LVESV、LVEF、E峰有恶化趋势,差异有统计学意义（P〈0.05）。治疗后,A组房颤发作次数、房颤持续时间、左房内径较治疗前有所改善,差异有统计学意义（P〈0.05）,且与B组差异有统计学意义（P〈0.05）;治疗后5、7d,A组心房颤动转复率高于B组,差异均有统计学意义（P〈0.05）;A组住院时间较B组缩短,差异有统计学意义（P〈0.05）,死亡率低于B组,差异有统计学意义（P〈0.05）。结论单纯胺碘酮对AMI合并AF患者心功能的改善效果不大,并不能降低AF的发作次数、时间,也很难提高转复率。胺碘酮联用ACEI类药物后,其效果明显提升,患者超声心动图结果有进步。

Objective To assess the therapeutic effect of angiotensin converting enzyme inhibitor（ACEI）on acute myocardial infarction（AMI）with atrial fibrillation（AF）. Methods Clinical data of AMI patients with AF in Renmin Hospital of Wuhan University were retrieved from January 2005 to July 2015.Patients were randomly divided into two groups according to the date of hospitalization with 14 000 cases in each group.Patients in group B were treated with amiodarone alone,150 mg injected intravenously for the first dose,then 200 mg once a day for those with AF.Patients in group A were also given ACEI besides aminodarone,4mg once a day for 6months.The changes of ECG and AF were observed.Student t test and chi-square test were used for data analysis. Results 24 weeks later,the LVMWg,LVEDV,LVESV,LVEF,E,A,E/A, WMSI in group A were significantly improved than those in group B（P〈0.05）;while,LVMWg,LVEDV,LVESV,LVEF,E in group B got worse（P〈0.05）.After treatment,the AF in group A was improved in terms of times of attacks and duration of the attack,as well as left arterial diameter（P〈0.05）.After treatment,there was significant difference between two groups in the number of AF episodes,duration of AF and left arterial diameter（P〈0.05）.5days after treatment,the percentage of AF restoration was higher in group B than in group A（P〈0.05）.The length of hospital stay in group A was significantly shorter than that in group B,and the mortality was significantly lower than that in B group（P〈0.05）. Conclusions The therapeutic effect of ACEI combined with aminodarone on myocardial infarction with AF is greater than aminodarone alone,which can significantly improve the cardiac function.