替米沙坦联用胺碘酮在心房颤动复律后维持窦性心律的疗效观察(1)
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[摘要] 目的：观察替米沙坦联用胺碘酮在心房颤动(AF)复律后维持窦性心律的作用及对左房内径的影响。方法：87例心房颤动(房颤)患者，复律后随机分为两组，对照组给予胺碘酮治疗，试验组给予胺碘酮+替米沙坦治疗。观察两组治疗后房颤复发情况和左心房内径变化。结果：随访1年后试验组窦性心律的维持率为82.9%(34/41)明显高于对照组的72.5%(29/40)，差异有统计学意义(P<0.05)；试验组治疗后较治疗前左房内径显著缩小(P<0.05)，对照组治疗前后差异无统计学意义(P>0.05)。结论：替米沙坦联用胺碘酮在房颤复律后维持窦性心律较单用胺碘酮更有效，并可逆转左房扩大。
[关键词] 心房颤动；替米沙坦；胺碘酮；复发
[中图分类号] R972+.2 [文献标识码]A[文章编号]1673-7210(2011)07(c)-085-02
Efficacy of Telmisartan with Amiodarone in the maintenance of sinus rhythm after cardioversion of atrial fibrillation
LU Changyong, LI Jingli
Department of Cardiology, the Second People′s Hospital of Kaifeng City, He′nan Province, Kaifeng 475002, China
[Abstract] 0bjective: To observe efficacy of Telmisartan with Amiodarone in the maintenance of sinus rhythm after cardioversion of atrial fibrillation (AF) and its influence on left atrial diameter. Methods: 87 patients with atrial fibrillation were randomly divided into two groups after cardioversion, control group was given Amiodarone; test group was given Amiodarone and Telmisartan treatment. To observe atrial fibrillation recurrence rate and changes of left atrial diameter. Results: After 1 year follow-up, maintenance rate of sinus rhythm in test group (82.9%) was significantly higher than the control group (72.5%), there was statistically differences (P<0.05); Left atrial diameter of test group significantly reduced after treatment (P<0.05), but that control group had no difference before and after treatment (P>0.05). Conclusion: Efficacy of Telmisartan with Amiodarone in the maintenance of sinus rhythm after cardioversion of atrial fibrillation is better than Amiodarone, and it can change left atrial enlargement.
[Key words] Atrial fibrillation; Telmisartan; Amiodarone; Recurrence
临床多种心脏疾病均可引起房颤(AF)，由于心房重构，房颤复律成功后又极易复发[1]。临床研究表明肾素-血管紧张素系统(RAS)激活可引起心房重构，因此血管紧张素Ⅱ受体阻滞剂(ARB)具有预防房颤发生及维持窦性心律的作用。本研究旨在观察血管紧张素Ⅱ受体阻滞剂(ARB)——替米沙坦逆转心房重构、维持窦性心律的临床效果。
1 资料
与方法
1.1 一般资料
选择2008年2月～2010年2月我院门诊及住院复律成功的的87例AF患者作为研究对象。入选患者AF发作病程为7 d～1年，有AF发作心电图或动态心电图证实，心功能(NYHA)Ⅰ～Ⅱ级。所有患者均常规行肝、肾功能、甲状腺功能检查，静脉应用胺碘酮复律后行超声心动图检查。
排除标准：①甲状腺功能亢进；②严重肝肾疾患；③电解质紊乱；④急性冠脉综合征。入选患者经复律后随机分为试验组(44例患者给予胺碘酮加替米沙坦治疗)、对照组(43例患者单用胺碘酮治疗)，两组患者基础疾病、年龄、性别、平均血压等比较，差异无统计学意义，见表1。
1.2 方法
复律后两组患者均正规服用胺碘酮(商品名可达龙)，第1周600 mg/d，第2周400 mg/d，第3周200 mg/d，至试验结束；试验组在此基础上加用替米沙坦 ......
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