华法林联合抗血小板药物治疗急性心肌梗死伴左心室室壁瘤疗效观察  

Observation on Efficacy of Warfarin Combined with Antiplatelet Drugs on Patients with Acute Myocardial Infarction Complicated with Left Ventricular Aneurysm

作　　者：兰建军[1] 王琳[2] 王世海[1] 曾晓斌[1] 杨超[1] 吴登轩 郑学忠 文亚红[1] 钱昌明[1] 徐大文[1] Lan Jianjun;Wang Lin;Wang Shihai;Zeng Xiaobin;Yang Chao;Wu Dengxuan;Zheng Xuezhong;Wen Yahong;Qian Changming;Xu Dawen(Department of Cardiology,Panzhihua Central Hospital,Panzhihua 617067,Sichuan,China;Sanming Ward of the Third People’s Hospital of Panzhihua City)

机构地区：[1]攀枝花市中心医院心内科,四川攀枝花617067 [2]攀枝花市第三人民医院老年明智病区

出　　处：《药物流行病学杂志》2021年第8期521-525,535,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:观察华法林联合抗血小板药物治疗急性心肌梗死(AMI)伴左心室室壁瘤(LVA)患者的临床疗效。方法:92例AMI伴LVA患者随机分为观察组和对照组各46例。经皮冠状动脉介入术(PCI)后,对照组予小剂量阿司匹林+氯吡格雷维持治疗;观察组在对照组基础上联用华法林维持治疗。两组均连续治疗6个月。比较两组治疗前后的心功能[左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)、左室射血分数(LVEF)],血清胶原Ⅰ型C端胶原前肽(PⅠCP)、Ⅲ型N端胶原前肽(PⅢNP),心室造影结果(相角程、半高宽、相位标准差)及动态心室ERNA反常容积显像结果;观察并记录两组治疗6个月内出血事件发生率和随访1年间心脏不良事件发生率及死亡率。结果:治疗7 d和治疗30 d后,两组LVESVI、LVEDVI、LVEF均较治疗前明显改善,血清PⅠCP、PⅢNP水平均低于治疗前(P<0.05);且观察组上述指标均明显优于对照组(P<0.05)。治疗7 d和治疗6个月后,两组心室造影的相角程、半高宽、相位标准差等均较治疗前降低,反常容积指数也明显低于治疗前(P<0.05),且观察组各项指标均低于对照组(P<0.05)。治疗6个月后观察组反常容积消失率高于对照组(P<0.05)。观察组治疗6个月内的出血事件发生率略高于对照组(P<0.05),但两组均未出现危及生命的大出血。随访1年间,观察组心脏不良事件发生率低于对照组(P<0.05),两组死亡率无明显差异(P>0.05)。结论:华法林联合抗血小板方案治疗AMI伴LVA临床效果良好,可有效减少胶原合成,逆转心室重构及LVA形成,提高患者心功能,降低心脏不良事件风险,虽然一定程度增加出血事件,但未造成严重不良影响。Objective:To investigate the clinical effect of warfarin combined with antiplatelet regimen in the treatment of patients with acute myocardial infarction(AMI)with left ventricular aneurysm(LVA).Methods:92 AMI patients with LVA were randomly divided into observation group and control group,46 cases in each group.After percutaneous coronary intervention(PCI),the control group was treated with low-dose aspirin and clopidogrel,and the observation group was treated with warfarin on the basis of the control group for 6 months.The cardiac function[left ventricular end systolic volume index(LVESVI),left ventricular end diastolic volume index(LVEDVI),left ventricular ejection fraction(LVEF)],serum procollagen typeⅠC-terminal(PⅠCP)and procollagen typeⅢN-terminal(PⅢNP)levels,and the results of ventriculography(phase angle,half width,left ventricular ejection fraction)were compared between the two groups before and after treatment The results of phase standard deviation(PSD)and dynamic abnormal volume imaging were compared;The incidence of bleeding events within 6 months of treatment and the incidence of adverse cardiac events and mortality within 1 year of follow-up were observed and compared between the two groups.Results:LVESVI,LVEDVI and LVEF were significantly improved in the two groups after 7 days and 30 days of treatment,serum PⅠCP and PⅢNP levels were lower than before(P<0.05);and the indexes of the observation group were superior to the control group(P<0.05).After 7 days and 6 months of treatment,the phase angle range,half-height width and phase standard deviation of the two groups were lower than before(P<0.05),and the abnormal volume index was lower than before treatment(P<0.05);and the indexes of the observation group were much better than that of the controll group(P<0.05).After 6 months treatment,the abnormal volume loss rate of the observation was higher than that of the control group(P<0.05).Within 6 months of medication,the incidence of bleeding events in the observation group was slightly highe

关 键 词：急性心肌梗死 左心室室壁瘤 经皮冠状动脉介入术 华法林 阿司匹林 氯吡格雷 心功能 血清胶原 

分 类 号：R973.2[医药卫生—药品]