氯沙坦和开搏通对急性心肌梗塞后左心室收缩同步性影响的对比研究

目的对比血管紧张素Ⅱ受体拮抗剂和血管紧张素转换酶抑制剂对急性心肌梗塞(AMI)后左心室收缩同步性(LVSS)的影响。 方法100例AMI患者随机分为常规治疗组20例、开搏通组40例、氯沙坦组40例，于AMI后1周、4周、28周进行平衡法核素心室造影和心室相位分析，获得相位分布/直方图和LVSS参数。 结果AMI后28周时，氯沙坦组和开搏通组与其AMI后1周比较梗塞区延迟相位均有明显改善，直方图曲线负偏态消失。AMI后28周时开搏通组LVSS定量参数左心室相角程、左心室半高宽和左心室峰相位标准差分别较AMI后1周时降低25.43%、35.86%和21.41%(P均＜0.05)，氯沙坦组左心室相角程、左心室半高宽和左心室峰相位标准差分别降低33.04%(P＜0.05)、51.47%(P＜0.01)和27.58%(P＜0.01)，而常规治疗组1周、4周、28周时各参数无明显变化。AMI后28周时氯沙坦组和开搏通组较常规治疗组左心室相角程、左心室半高宽和左心室峰相位标准差分别减少29.90%和25.91%(P均＜0.01)、50.77%(P＜0.01)和44.33%(P＜0.05)、23.43%和25.27%(P均＜0.05)。而且氯沙坦组与开搏通组间相位分布和上述各参数比较并无显著性差异。 结论血管紧张素Ⅱ受体拮抗剂氯沙坦能明显提高LVSS，改善左心室功能，且其效果与血管紧张素转换酶抑制剂开搏通相近。

A Comparison Study of Losartan and Captopril on the Left Ventricular Systolic Synchrony Following Acute Myocardial Infarction

Objective:To compare the effect on left ventricular systolic synchrony (LVSS) of angiotension II antagonist(AIIA) losartan versus angiotensin converting enzyme inhibitors(ACEI) captopril after acute myocardial infarction(AMI). Methods:A total of 100 patients with AMI were enrolled in our study.Twenty patients were randomized into conventional treatment group,40 into captopril group and the other 40 into losartan group.The phase imaging and phase histogram of ventricle were observed and the parameters of LVSS(PS,PSD and FWHM) were measureed in all patients of the three groups at 1,4 and 28 weeks after AMI using the technique of phase analysis of equilibrium radionuclide angiography. Results:At 28 weeks after AMI,phase distribution imaging and phase histogram of ventricle were significantly improved in losartan and captopril treatment groups.There was no difference in the LVSS parameters of the three groups at 1 and 4 weeks after AMI.Losartan and captopril treatment groups (28 weeks) were characterized by significantly decreased LPS by 29.90% and 25.91%( p <0 01) LFWHM by 50.77%( p <0 01) and 44.33%( p <0 05) LPSD by 23 43% and 25.27% ( p <0.05)compared with the conventional treatment group.There was no difference between the losartan and captopril treatment groups. Conclusions:Losartan significantly improved the left ventricular systolic synchrony.The effect of losartan was similar to that of captopril.