Application value of metoprolol combined with daglizin in improving cardiac function and ventricular remodeling in patients with acute myocardial infarction after percutaneous coronary intervention
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摘要: 目的 探讨美托洛尔联合达格列净在改善急性心肌梗死(acute myocardial infarction，AMI)经皮冠状动脉介入术(percutaneous coronary intervention，PCI)患者心功能及心室重构中的应用价值。方法 选取2022年1月至2023年10月收治的AMI-PCI患者86例，按随机表分为实验组(43例)和对照组(43例)。对照组给予美托洛尔+常规治疗，实验组在此基础上联合达格列净治疗，比较2组心功能[左心射血分数(LVEF)、心脏指数(CI)、每搏输出量(SV)]、心室重构[左心室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室舒张末期内径(LVEDD)]、实验室指标[N末端B型钠尿肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)]、不良心血管事件及不良反应。结果 治疗后，2组LVEF、CI、SV明显高于治疗前，且实验组LVEF、CI、SV明显高于对照组(P＜0.05)。治疗后，2组LVEDV、LVESV、LVEDD和NT-proBNP、hs-CRP、IL-6明显低于治疗前，且实验组LVEDV、LVESV、LVEDD和NT-proBNP、hs-CRP、IL-6明显低于对照组(P＜0.05)。治疗后，实验组不良心血管事件发生率明显低于对照组(P＜0.05)；2组不良反应发生率基本相同(P>0.05)。结论 美托洛尔联合达格列净可改善AMI-PCI患者的心功能及心室重构，有利于改善预后，且安全性好，值得临床推广。Abstract: Objective To discuss the application value of metoprolol combined with daglizin in improving cardiac function and ventricular remodeling in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI).Methods A total of 86 patients with AMI-PCI from January 2022 to October 2023 were selected and divided into experimental group(43 cases) and control group(43 cases) according to a random table. Patients in the control group were given metoprool + conventional treatment, and patients in the experimental group were given combined treatment with daglizin on this basis. The cardiac function(left ejection fraction[LVEF], heart index[CI], stroke output[SV]), ventricular remodeling(left ventricular end-diastolic volume[LVEDV], left ventricular end-systolic volume[LVESV], left ventricular end-diastolic diameter[LVEDD]) and laboratory parameters(N-terminal B-type natriuretic peptide precursor[NT-proBNP], hypersensitive C-reactive protein[hs-CRP], interleukin-6[IL-6]), adverse cardiovascular events and adverse events were compared between the two groups.Results After treatment, the LVEF, CI and SV of the two groups were significantly higher than those before treatment, and the LVEF, CI and SV in the experimental group were significantly higher than those in the control group(P < 0.05). After treatment, the LVEDV, LVESV, LVEDD, NT-proBNP, hs-CRP and IL-6 of the two groups were significantly lower than those before treatment, and LVEDV, LVESV, LVEDD, NT-proBNP, hs-CRP and IL-6 in the experimental group were significantly lower than those in the control group(P < 0.05). The incidence of adverse cardiovascular events in the experimental group was significantly lower than that in the control group(P < 0.05). The adverse events rate of the two groups was basically the same(P>0.05).Conclusion Metoprolol combined with daglizin can improve cardiac function and ventricular remodeling in patients with AMI-PCI, which is beneficial for prognosis improvement, and it is worthy of clinical promotion.
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表 1 2组一般资料比较
组别 例数 男∶女/例 糖尿病/例 高血压/例 Killip分级/例 年龄/岁 体重指数/(kg/m2) 病程/h 是 否 是 否 Ⅰ Ⅱ 对照组 43 23∶20 8 35 21 22 30 13 57.62±6.82 22.41±2.78 5.26±0.58 实验组 43 26∶17 10 33 18 25 28 15 56.91±6.58 22.79±2.83 5.38±0.60 χ2/t 0.427 0.281 0.422 0.212 0.491 0.628 0.943 P 0.514 0.596 0.516 0.645 0.625 0.532 0.348 
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表 2 2组心功能指标比较
组别 例数 LVEF/% CI/[L/(min·m2)] SV/mL 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 43 40.38±4.72 46.37±5.271) 2.87±0.38 3.12±0.431) 55.27±5.82 61.72±6.731) 实验组 43 40.85±4.86 54.18±5.961) 2.81±0.36 3.53±0.481) 55.88±5.95 68.34±6.961) t 0.455 6.437 0.752 4.172 0.481 4.484 P 0.650 ＜0.001 0.454 ＜0.001 0.632 ＜0.001 与同组治疗前比较，1)P＜0.05。
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表 3 2组心室重构指标比较
组别 例数 LVEDV/mL LVESV/mL LVEDD/mm 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 43 121.08±3.58 113.16±3.251) 58.76±3.24 54.73±3.081) 51.42±1.28 49.43±1.061) 实验组 43 121.89±3.67 105.73±3.041) 58.26±3.18 49.87±3.011) 51.21±1.25 47.53±1.021) t 1.036 10.948 0.722 7.400 0.770 8.470 P 0.303 ＜0.001 0.472 ＜0.001 0.444 ＜0.001 与同组治疗前比较，1)P＜0.05。
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表 4 2组实验室指标比较
组别 例数 NT-proBNP/(pg/mL) hs-CRP/(mg/L) IL-6/(ng/L) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 43 992.46±108.63 376.58±43.561) 13.57±1.85 7.63±0.851) 14.79±1.96 6.23±0.691) 实验组 43 983.72±106.58 287.62±36.721) 13.84±1.89 6.12±0.671) 14.28±1.91 5.31±0.581) t 0.377 10.239 0.669 9.149 1.222 6.693 P 0.707 ＜0.001 0.505 ＜0.001 0.225 ＜0.001 与同组治疗前比较，1)P＜0.05。
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表 5 2组不良反应发生率比较
例(%) 组别 例数 恶心呕吐 低血压 低血糖 肾功能异常 合计 对照组 43 2(4.65) 2(4.65) 0 0 4(9.30) 实验组 43 0 2(4.65) 2(4.65) 2(4.65) 6(13.95) χ2 0.453 P 0.501
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