盐酸普罗帕酮对改善急性心肌梗死伴心律失常临床症状及预后的应用研究

Application of propafenone hydrochloride in improving clinical symptoms and prognosis of acute myocardial infarction with arrhythmia

目的:观察盐酸普罗帕酮对改善急性心肌梗死(AMI)伴心律失常临床症状及预后的应用效果。方法:本研究为前瞻性病例对照研究,选取2021年1月至2023年1月南阳医学高等专科学校第一附属医院神经内科三病区收治的118例AMI伴心律失常患者,男63例,女55例,年龄(60.23±5.16)岁,年龄范围为45~75岁。采用随机数表法将患者随机分为常规药物组与盐酸普罗帕酮组,每组59例,常规药物组予以常规药物治疗,盐酸普罗帕酮组采用盐酸普罗帕酮配合治疗。比较两组患者治疗前后的心电图参数[QT间期、Tp-Te间期、QT时限离散度(QTd)]、心功能[左室射血分数(LEVF)、左室舒张末期内径(LVDD)、左室后壁厚度(LVPW)]、基础体征指标(心率、收缩压、舒张压)及不良反应发生情况,统计并比较两组患者随访期间的主要心血管不良事件(MACE)。结果:治疗前,两组患者的心电图参数、心功能、基础体征比较,差异均无统计学意义( P>0.05)。治疗后,盐酸普罗帕酮组的QT间期[(431.25±50.64)ms]、Tp-Te间期[(122.36±20.47)ms]、QTd[(50.77±10.28)ms]均低于常规药物组[(470.25±50.35)ms、(136.47±20.25)ms、(56.32±10.41)ms];LVEF[(55.25±10.37)%]高于常规药物组[(48.33±10.61)%],LVDD[(40.13±10.25)mm]、LVPW[(9.12±2.25)mm]低于常规药物组[(46.62±10.36)mm、(10.67±2.05)mm];心率[(75.11±5.28)次/分]、收缩压[(125.11±10.46)mmHg,1 mmHg=0.133 kPa]、舒张压[(80.33±10.24)mmHg]均低于常规药物组[(78.66±5.27)次/分、(132.11±10.35)mmHg、(86.62±10.37)mmHg],差异均有统计学意义( P<0.05)。两组患者不良反应发生情况比较,差异无统计学意义( P>0.05)。盐酸普罗帕酮组患者随访期间的MACE发生率[5.1%(3/59)]低于常规药物组[20.3%(12/59)],差异有统计学意义( P<0.05)。 结论:盐酸普罗帕酮能有效改善AMI合并心律失常患者的心电图参数,对促进患者心功能、基础体征恢复并降低MACE发生风险均有积极意义,且应用此药安全性较高,未明显增加患者的药物不良反应发生风险。

ObjectiveObserve the application effect of propafenone hydrochloride on improving clinical symptoms and prognosis of acute myocardial infarction(AMI)with arrhythmia.MethodsThis study was a prospective case-control study that selected 118 patients with AMI and arrhythmia admitted to the Three Wards of Neurology in the First Affiliated Hospital of Nanyang Medical College from January 2021 to January 2023,there were 63 males and 55 females,aged(60.23±5.16)years old,ranging from 45 to 75 years old.Using a random number table method,patients were divided into conventional drug group and propafenone hydrochloride group,with 59 patients in each group.The conventional drug group received conventional drug treatment,while the propafenone hydrochloride group received propafenone hydrochloride combined treatment.Compare the electrocardiogram parameters[QT interval,Tp-Te interval,QT dispersion(QTd)],cardiac function[left ventricular ejection fraction(LEVF),left ventricular end diastolic diameter(LVDD),left ventricular posterior wall thickness(LVPW)]between the two groups of patients before and after treatment basic physical indicators(heart rate,systolic blood pressure,diastolic blood pressure)and incidence of adverse reactions were analyzed and compared.Major adverse cardiovascular events(MACE)during the follow-up period were recorded and compared between the two groups of patients.ResultsBefore treatment,there was no statistically significant difference in electrocardiogram parameters,cardiac function,and basic physical signs between the two groups of patients(P>0.05).After treatment,the QT interval[(431.25±50.64)ms],Tp-Te interval[(122.36±20.47)ms]and QTd[(50.77±10.28)ms]of the propafenone hydrochloride group were lower than those of the conventional drug group[(470.25±50.35)ms,(136.47±20.25)ms and(56.32±10.41)ms],the LVEF of the experimental group[(55.25±10.37)%]was higher than that of the conventional group[(48.33±10.61)%],the LVDD[(40.13±10.25)mm]and the LVPW[(9.12±2.25)mm]were lower than that of the conventional group[(46.62±10.36)mm,(10.67±2.05)mm],the heart rate of the experimental group[(75.11±5.28)times/min],systolic blood pressure[(125.11±10.46)mmHg,1 mmHg=0.133 kPa],and diastolic blood pressure[(80.33±10.24)mmHg]were lower than that of the conventional group[(78.66±5.27)times/min,(132.11±10.35)mmHg,(86.62±10.37)mmHg],the differences were statistically significant(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).The incidence of MACE during follow-up was significantly lower in the propafenone group[5.1%(3/59)]than in the conventional group[20.3%(12/59)],the difference was statistically significant(P<0.05).ConclusionsPropafenone hydrochloride can effectively improve the electrocardiogram parameters of patients with AMI combined with arrhythmia,promote the recovery of cardiac function and basic physical signs,and reduce the risk of MACE.Moreover,the use of this drug has high safety and does not significantly increase the risk of adverse drug reactions in patients.