螺内酯对急性心肌梗死患者左心室重塑的影响

目的 探讨应用小剂量螺内酯对急性心肌梗死（AMI）患者左心室重塑的影响。方法 AMI患者84例，按梗死部位分为前壁心肌梗死组（43例）和下壁心肌梗死组（41例），两组患者再随机分为螺内酯治疗组和常规治疗组，于发病后1周、3个月和6个月行二维超声心动图检查，观测左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、左心室舒张末期容积指数（LVEDVI）和左心室收缩末期容积指数（LVESVI）。结果 前壁心肌梗死组：6个月时螺内酯组LVEDD、LVESD、LVEDVI和LVESVI与对照组相比明显下降（P〈0．05），而LVEF升高差异有显著性（P〈0．05）；下壁心肌梗死组：两组在治疗6个月时上述指标差异均无显著性（P〉0．05）。结论 常规治疗的基础上联合应用小剂量螺内酯，可进一步防止前壁AMI患者左心室重塑的发生，对下壁AMI患者未见明显差异。

Effect of spironolactone on the left ventricular remodeling in patients with acute myocardial infarction

Objective To evaluate the effect of spironolactone on the left ventricular remodeling(LVRM) in acute myocardial infarction(AMI) patients.Methods 84 AMI cases were randomly divided into anterior MI group(n=43) and inferior MI group(n=41).Each group was randomly subdivided into spironolactone intervention group and routine treatment group.All patients were examined with two dimensional echocardiography.Left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular end diastolic volume index(LVEDVI),left ventricular end systolic volume index(LVESVI) and ejection fraction(LVEF) were measured on the 1st week,3rd,and 6th month.Results After 6 month intervention,the spironolactone subgroup in anterior MI group had a lowered LVEDD,LVESD,LVEDVI and LVESVI compared with control group(P<0.05).LVEF was of significant difference between groups,while there was no significant difference in LVEDD,LVESD,LVESVI and LVEF between subgroups of inferior MI group 6 months after intervention(P>0.05).Conclusion Those findings indicate that in patients with anterior AMI,spironolactone combined with routine treatment may prevent left ventricular remodeling,which exerts no significant difference in patients with inferior AMI.