氯沙坦联合胺碘酮在阵发性房颤复律及维持复律后窦性心率中的应用效果分析

摘要

目的：探讨阵发性房颤患者应用氯沙坦联合胺碘酮的临床复律效果及对患者维持复律后窦性心率的意义。方法：2010年1月-2013年3月将72例非瓣膜病阵发性房颤患者按随机数字表法分为对照组36例和观察组36例，对照组给予胺碘酮治疗，观察组给予氯沙坦+胺碘酮治疗，比较治疗24 h、3 d和7 d时房颤的转复情况。在房颤复律后，继续药物治疗并随访观察1年，评价两组窦性心率的维持效果。结果：对照组治疗24 h、3 d和7 d房颤的转复率分别为72.2%（26/36）、83.3%（30/36）和91.7%（33/36），观察组的转复率分别为69.4%（25/36）、88.9%（32/36）和97.2%（35/36），观察组在7 d时房颤转复率较对照组明显升高（P<0.05）。两组窦性心率在治疗12个月时维持率分别为69.7%（23/33）和88.6%（31/35）（P<0.05），两组左房内径分别为（38.3±1.9）mm和（34.2±2.0）mm（P<0.05）。结论：阵发性房颤患者应用氯沙坦联合胺碘酮复律效果及维持复律后的窦性心率均优于单用胺碘酮治疗，可能与氯沙坦抑制肾素-血管紧张素系统，降低心脏负荷，抑制心房电及结构重构有关。%Objective:To investigate the clinical effect of losartan combined with amiodarone in patients with paroxysmal atrial fibrillation cardioversion and maintenance of sinus heart rate after cardioversion.Method:From January 2010 to March 2013,72 patients with nonvalvular paroxysmal atrial fibrillation randomly were given amiodarone therapy (control group 36 cases)and losartan combined with amiodarone therapy(observation group 36 cases),cardioversion of atrial fibrillation was compared after treatment for 24 h,3 d and 7 d. After cardioversion of atrial fibrillation,patients were continued to give drug treatment and followed up for 1 year,the maintenance effect of sinus heart rate was evaluated of the two groups.Result:The atrial fibrillation cardioversion rate in control group after treatment for 24 h,3 d and 7 d was 72.2%(26/36),83.3%(30/36)and 91.7%(33/36),the observation group was 69.4%(25/36),88.9%(32/36) and 97.2%(35/36),the atrial fibrillation cardioversion rate in observation group after treatment for 7 d was significantly increased as compared with the control group(P<0.05).The maintenance of sinus heart rate in two groups after treatment for 12 months were 69.7%(23/33)and 88.6%(31/35)(P<0.05),and the left atrial diameter in two groups were (38.3±1.9)mm and(34.2±2.0)mm(P<0.05).Conclusion:Application effect of losartan combined with amiodarone in patients with paroxysmal atrial fibrillation cardioversion and maintenance of sinus heart rate after cardioversion are both better than the single use of amiodarone treatment,it may be related to the inhibitory effect of losartan on the renin-angiotensin system,reducing the load on the heart,electrical and structural remodeling of atrialrelated inhibition.