通过皮肤注射的酸甘贴片治疗改善左心室功能,并防止急性心肌梗塞后的重塑:多中心前性随机,双盲,安慰剂控制试验的结果
J J Mahmarian1, L A Moyé, D A Chinoy
1Baylor College of Medicine, Houston, Tex, USA. johnj@bcm.tmc.edu
Circulation
|June 4, 1998
概括
在急性心肌梗塞 (AMI) 后,间歇性通过皮肤注射的酸甘 (NTG) 贴片有效地防止左心室 (LV) 扩张. 在患有 LV 功能减弱的患者中,在最低剂量时观察到益处,需要持续服用.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 酸盐是急性心肌梗塞 (AMI) 中心痛的标准.
- 短期使用酸盐限制左心室 (LV) 扩张和心脏病扩张.
- 在Q波AMI幸存者中对LV重塑的长期影响不太清楚.
研究的目的:
- 在AMI幸存者中评估间歇性通过皮肤注射酸甘 (NTG) 贴片对LV重塑的6个月疗效.
- 确定最佳剂量和从NTG治疗中受益的患者子组.
主要方法:
- 随机,双盲,安慰剂对照试验.随机,双盲,安慰剂对照试验.
- 291名AMI幸存者接受了NTG贴片 (0.4,0.8,1.6毫克/小时) 或安慰剂.
- 放射性核素血管造影 (RNA) 在基线和6个月评估了LV重塑.
主要成果:
- 0.4毫克/小时的NTG剂量显著降低了末缩体积指数 (ESVI) 和末缩体积指数 (EDVI).
- 在基线LV射出分数≤40%的患者中,益处最为明显.
- 在NTG退出后,ESVI增加,但仍低于基线水平.
结论:
- 通过皮肤的NTG贴片可以防止AMI幸存者的LV扩张.
- 疗效取决于剂量 (0.4毫克/小时),并且特定于患有 LV 功能抑郁的患者.
- 持续的效果需要持续的NTG给药;需要进行临床结果试验.
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