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目的探讨急性心肌梗死(AMI)早期应用不同剂量的AT1受体拮抗剂对左室重构的远期疗效。方法选择首次AMI患者120例,在常规治疗基础上(包括硝酸酯类、β受体阻滞剂、阿司匹林、低分子肝素),随机分为卡托普利(C)组:12·5~25·0mg,3次/d;缬沙坦(D1)组:代文80mg,1次/d;缬沙坦(D2)组:代文,起始量为80mg,1次/d,2周后血压平稳且患者能耐受时增至160mg,1次/d,患者均分别于治疗1、6、12、18个月对心室重构及心功能有关指标进行检测。结果(1)短期应用(1年内)3组患者的LA、LVDd、IVSd、LVPWd、LVMI间差异无显著性意义;用药1年后,缬沙坦组与卡托普利组上述指标间差异有显著性意义(P<0·05);(2)缬沙坦组治疗1年后与卡托普利组心功能差异有显著性意义(P<0·05),且疗效与剂量相关。结论AT1受体拮抗剂缬沙坦与血管紧张素转换酶抑制剂卡托普利一样,早期应用能有效防治AMI后心室重构,保护心功能,其远期疗效可能优于卡托普利,且疗效与剂量相关。
Objective To investigate the long-term effect of early application of different doses of AT1 receptor antagonist on left ventricular remodeling in acute myocardial infarction (AMI). Methods A total of 120 AMI patients were selected and randomly divided into captopril group (C) on the basis of routine treatment (including nitrates, β blockers, aspirin and low molecular weight heparin): 12.5 ~ 25 · Valsartan (D1) group: Daiwen 80mg, 1 time / d; valsartan (D2) group: Daiwen, the initial amount of 80mg, 1 time / d, 2 weeks Blood pressure was stable and the patient tolerated when increased to 160mg, 1 / d, patients were treated at 1,6,12,18 months of ventricular remodeling and cardiac function related indicators were measured. Results (1) There was no significant difference in LA, LVDd, IVSd, LVPWd and LVMI between the three groups in the short-term application (within 1 year). One year after the administration, there was significant difference between the valsartan and captopril groups (P <0.05). (2) There was significant difference in cardiac function between captopril group and valsartan group after one year (P <0.05), and the effect was dose-dependent. Conclusions As the AT1 receptor antagonist valsartan, like angiotensin converting enzyme inhibitor captopril, its early application may be effective in preventing and treating ventricular remodeling and protecting cardiac function after AMI. Its long-term efficacy may be superior to that of captopril, And efficacy and dose related.