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目的：为了探讨血管紧张素转化酶抑制剂（ＡＣＥＩ）对急性心肌梗死（ＡＭＩ）后的抗缺血作用和对左心室结构的远期影响。方法：１１０例ＡＭＩ患者于发病后７天随机分为卡托普利（１２．５ｍｇ，每日２次）和对照组，定期检查超声心动图、动态心电图及单光子发射计算机体层摄影（ＳＰＥＣＴ），随访观察１年（ｎ＝１０２）。结果：卡托普利组（ｎ＝５１）心肌缺血负荷从发病７天至６个月呈进行性减低。１年后卡托普利组核素缺损面积缩小（Ｐ＜０．０１），节段射血分数明显增加（Ｐ＜０．００１），与对照组（ｎ＝５１）比较有显著性差异（Ｐ＜０．０１，Ｐ＜０．００１）。对照组Ｑ波型心肌梗死左心室收缩末期和舒张末期容量指数均呈进行性增加，卡托普利组舒张末期容量指数轻度增加（Ｐ＜０．０５），而收缩末期容量指数则明显降低（Ｐ＜０．０１）。相关分析表明，Ｑ波型心肌梗死心室容量变化与心肌缺血总负荷之间呈正相关（ｒ＝０．８１，Ｐ＜０．０１）。结论：卡托普利对ＡＭＩ后６个月内左心室的明显扩张，有显著抑制作用。其抗缺血作用机制及可能对梗死周围存活心肌的作用有待进一步研究。Ｐ＜０．００１２４小时动态心电图对心肌缺血负荷观察表明，卡托普利组从发病第７天至６个月间心肌缺血?
AIM: To investigate the anti-ischemic effect of angiotensin converting enzyme inhibitor (ACEI) on acute left ventricular infarction (AMI) and its long-term effect on left ventricular structure. Methods: One hundred and ten patients with AMI were randomly divided into captopril (12.5mg, twice a day) and control group 7 days after onset. The echocardiography, dynamic electrocardiogram and single photon emission computed tomography (SPECT) ), Followed up for 1 year (n = 102). Results: Captopril group (n = 51) had a progressive decrease of myocardial ischemic load from 7 days to 6 months after onset. After 1 year, the area of radionuclide defects in captopril group decreased (P <0.01), the segmental ejection fraction increased significantly (P <0.001), and there was significant difference compared with control group (n = 51) P <0.01, P <0.001). The left ventricular end-systolic and end-diastolic volume indices of Q-wave myocardial infarction were increased in the control group, while the end-diastolic volume index of captopril group was slightly increased (P <0.05), while the end-systolic volume index was significantly decreased (P <0.01). Correlation analysis showed that there was a positive correlation between changes of ventricular volume and total myocardial ischemic load in Q wave myocardial infarction (r = 0.81, P <0.01). CONCLUSION: Captopril has a significant inhibitory effect on the significant left ventricular dilatation within 6 months after AMI. Its anti-ischemic mechanism and its possible role in the survival of myocardial infarction remains to be further studied. P <0.00124 hours Holter monitoring of myocardial ischemia load showed that captopril group from the onset of 7 days to 6 months of myocardial ischemia?