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目的评价血管紧张素转换酶抑制剂(ACEI)治疗急性心肌梗死(AMI)合并心房颤动(AF)的治疗效果。方法回顾性分析2005年1月~2015年7月于武汉大学人民医院就诊的急性心肌梗死合并心房颤动患者28 000例临床资料。按照入院顺序将AMI合并AF患者随机分为A、B两组,每组14 000例。A组患者在胺碘酮基础上联用ACEI类药物,起始剂量4mg/次、1次/d;B组患者予胺碘酮,首剂150mg静脉推注,偶发心房颤动者口服维持,200mg/次、1次/d。观察两组患者的超声心动图变化,AF转复情况,统计住院时间及院内死亡率等。采用SPSS 13.0软件,计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果 24周后,A组LVMWg、LVEDV、LVESV、LVEF、E峰、A峰、E/A、WMSI均较治疗后1周有进步,均优于B组,差异均有统计学意义(P<0.05);B组LVMWg、LVEDV、LVESV、LVEF、E峰有恶化趋势,差异有统计学意义(P<0.05)。治疗后,A组房颤发作次数、房颤持续时间、左房内径较治疗前有所改善,差异有统计学意义(P<0.05),且与B组差异有统计学意义(P<0.05);治疗后5、7d,A组心房颤动转复率高于B组,差异均有统计学意义(P<0.05);A组住院时间较B组缩短,差异有统计学意义(P<0.05),死亡率低于B组,差异有统计学意义(P<0.05)。结论单纯胺碘酮对AMI合并AF患者心功能的改善效果不大,并不能降低AF的发作次数、时间,也很难提高转复率。胺碘酮联用ACEI类药物后,其效果明显提升,患者超声心动图结果有进步。
Objective To evaluate the therapeutic effect of angiotensin converting enzyme inhibitor (ACEI) on acute myocardial infarction (AMI) combined with atrial fibrillation (AF). Methods The clinical data of 28 000 patients with acute myocardial infarction and atrial fibrillation who were treated at Wuhan University People’s Hospital from January 2005 to July 2015 were retrospectively analyzed. According to the order of admission, AM patients with AMI were randomly divided into A and B groups, with 14 000 cases in each group. A group of patients on the basis of amiodarone with ACEI drugs, the initial dose of 4mg / time, 1 / d; B group patients with amiodarone, the first dose of 150mg intravenous injection of occasional atrial fibrillation were maintained orally, 200mg / Times, 1 time / d. Echocardiographic changes, AF recovery, hospitalization time and hospital mortality were observed in two groups. Using SPSS 13.0 software, measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results After 24 weeks, the LVMWg, LVEDV, LVESV, LVEF, E peak, A peak, E / A and WMSI in group A were all improved compared with those in group B after 1 week, which were all better than group B 0.05). The LVMWg, LVEDV, LVESV, LVEF and E peak in group B tended to deteriorate with statistical significance (P <0.05). After treatment, the frequency of atrial fibrillation, the duration of atrial fibrillation and the left atrial diameter in group A were improved compared with that before treatment (P <0.05), and the difference was statistically significant (P <0.05) (P <0.05). The hospitalization time of group A was shorter than that of group B, the difference was statistically significant (P <0.05) .After treatment, the recovery rate of atrial fibrillation in group A was higher than that of group B , The mortality rate was lower than that in group B, the difference was statistically significant (P <0.05). Conclusions Amiodarone alone has little effect on improving cardiac function in patients with AMI complicated with AF, and can not reduce the number of episodes and time of AF. It is also difficult to improve the recovery rate. Amiodarone with ACEI drugs, the effect was significantly improved, the patient echocardiographic results have improved.