AMI后心力衰竭应用不同剂量培哚普利的疗效及对NT-proBNP及心肌能量消耗的影响  

Efficacy of different doses of perindopril in treatment of heart failure after AMI and its influence on NT-proBNP and myocardial energy expenditure

作　　者：龙骁[1] 陈然[1] 程春[1] 黄玉艳[1] 贾颖[1] 吴鹏翠[1] 

机构地区：[1]长沙市中心医院心血管内科,湖南长沙410011

出　　处：《中国临床研究》2017年第6期740-743,共4页Chinese Journal of Clinical Research

摘　　要：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 efficacy of different doses of perindopril for the treatment of heart failure following acute myocardial infarction （AMI） and its effects on N-terminal B type natriuretic peptide precursor （NT- proBNP） and myocardial energy expenditure. Methods Eighty patients with heart failure after AMI between June 2015 and June 2016 were enrolled in this study. The patients were randomly divided into two groups （n = 40 each） according to random number table method ： perindopril conventional dose group and perindopril high dose group. On the basis of the same routine treatment, perindopril of 4. 0 mg/d or 8.0 mg/d was respectively given for conventional dose group and high dose group. Enzyme linked immunosorbent assay （ELISA） was used to detect plasma NT-proBNP level. Color Doppler echocardiography was used to detect and calculate the related indexes of cardiac function and myocardial energy expenditure. The cardiac function, plasma NT-proBNP level and myocardial energy expenditure indexes before and after treatment in two groups were compared. Results There were no significant differences in systolic blood pressure, diastolic blood pressure, stroke volume （ SV）, left ventricular posterior wall thickness at systole （ PWTs ）, left ventricular ejection fraction （LVEF）, left ventricular internal diameter at end-systole （LVIDs）, left ventricular end systolic tension （left ventricular end systolic circumferential wall stress, cESS）, myocardial energy expenditure （MEE） and plasma NT-proBNP level before treatment in two groups （all P 〉 0.05 ）, and there were significant differences in them before and after treatment in two groups （ P 〈 0. 05, P 〈 0. 01 ）. After treatment, systolic blood pressure, diastolic blood pressure, PWTs,LVIDs, MEE, cESS, plasma NT-proBNP level in high dose group were all significantly lower than those in conventional dose group（P 〈0. 05 ,P 〈 0. 01 ）,while SV and LVEF in high dose group were significantly higher than th

关 键 词：急性心肌梗死 心力衰竭 培哚普利 N末端B型利钠肽前体 能量消耗 

分 类 号：R541.6[医药卫生—心血管疾病] R542.2[医药卫生—内科学]