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目的探讨急性心肌梗死(AMI)后心力衰竭患者应用不同剂量培哚普利治疗的疗效及对患者血浆N末端B型利钠肽前体(NT-pro BNP)及心肌能量消耗的影响。方法选取2015年6月至2016年6月AMI后心力衰竭患者80例,采用随机数字表法分为培哚普利常规剂量组及培哚普利高剂量组,每组40例。在相同的常规治疗基础上,常规剂量组给予培哚普利4.0 mg/d,高剂量组给予培哚普利8.0 mg/d。采用酶联免疫吸附法(ELISA)测定血浆NT-pro BNP水平,采用彩色多普勒超声心动图检测并计算心功能及心肌能量消耗相关指标。对比两组患者治疗前后的心功能、血浆NT-pro BNP及心肌能量消耗指标。结果治疗前,两组患者的收缩压、舒张压、每搏输出量(SV)、左室后壁厚度(PWTs)、左室射血分数(LVEF)、左室收缩末期内径(LVIDs)、左室收缩末期张力[左室收缩末期周向室壁应力(c ESS)]、心肌生物能量消耗(MEE)、血浆NT-pro BNP水平比较差异均无统计学意义(P均>0.05);治疗后,两组上述指标与治疗前比较均有统计学差异(P<0.05,P<0.01)。治疗后,高剂量组的收缩压、舒张压、PWTs、LVIDs低于常规组(P<0.05,P<0.01),SV、LVEF高于常规组(P均<0.05),MME[(1.20±0.16)cal/systole vs(1.42±0.20)cal/systole]、c ESS[(184.7±30.5)kdyn/cm~2vs(234.0±37.5)kdyn/cm~2]、NT-pro BNP[(1 208.4±520.7)ng/ml vs(1 551.8±620.4)ng/ml]低于常规组(P<0.05,P<0.01)。结论 AMI后心力衰竭患者应用高剂量培哚普利有助于进一步降低心肌能耗和血浆NT-pro BNP水平,提高心功能。
Objective To investigate the effect of different doses of perindopril in patients with heart failure after acute myocardial infarction (AMI) on the plasma N-terminal pro-brain natriuretic peptide (NT-pro BNP) and myocardial energy expenditure. Methods Eighty patients with heart failure after AMI from June 2015 to June 2016 were randomly divided into routine dose of perindopril group and high dose of perindopril group, 40 cases in each group. On the same routine treatment, the conventional dose group was given perindopril 4.0 mg / d and the high dose group was given perindopril 8.0 mg / d. Plasma NT-pro BNP levels were measured by enzyme-linked immunosorbent assay (ELISA). Color Doppler echocardiography was used to detect and calculate cardiac function and myocardial energy expenditure related indicators. The cardiac function, plasma NT-pro BNP and myocardial energy expenditure before and after treatment were compared between the two groups. Results Before treatment, systolic blood pressure, diastolic blood pressure, stroke volume (SV), left ventricular posterior wall thickness (PWTs), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVIDs) There were no significant differences in end-systolic tension (c ESS), myocardial bioenergetic energy (MEE) and plasma NT-pro BNP levels (all P> 0.05) after treatment There was significant difference between the two groups before and after treatment (P <0.05, P <0.01). After treatment, systolic blood pressure, diastolic blood pressure, PWTs and LVIDs in high-dose group were significantly lower than those in conventional group (P <0.05, P <0.01) ), cESS (184.7 ± 30.5) kdyn / cm 2 vs 234.0 ± 37.5 kdyn / cm 2, NT-pro BNP [(1 208.4 ± 520.7) ) ng / ml vs (1 551.8 ± 620.4) ng / ml] was lower than that of the conventional group (P <0.05, P <0.01). Conclusions The application of high-dose perindopril in patients with heart failure after AMI can further reduce myocardial energy consumption and plasma NT-pro BNP levels and improve cardiac function.