厄贝沙坦联合胺碘酮对不同心功能状态下阵发性心房颤动的长期疗效  

The Long-term Effects of Irbesartan Plus Amiodarone on the Recurrence of Atrial Fibrillation in Paroxysmal Atrial Fibrillation Patients With or Without Heart Failure

作　　者：魏江涛[1] 陈聪[1] 余国珍[1] 官亮[1] 李进[1] 万玲[1] 刘海 

机构地区：[1]江南昌大学第四附属医院干部病房,江西南昌330003

出　　处：《中华高血压杂志》2009年第8期729-732,共4页Chinese Journal of Hypertension

摘　　要：目的比较厄贝沙坦联合胺碘酮与单用胺碘酮对心功能轻度异常及心功能明显异常状态下阵发性心房颤动(PAF)维持窦性心律(窦律)的疗效。方法选择PAF患者147例随机分为厄贝沙坦(150mg/d)加胺碘酮联合治疗(600mg/d)治疗心功能轻度异常组(Ⅰ组,n=39);联合治疗心功能明显异常组(Ⅱ组,n=36);单用胺碘酮(600mg/d)治疗心功能轻度异常组(Ⅲ组,n=37);以及心功能明显异常组(Ⅳ组,n=35),治疗随访时间为一年。研究终点为12导联心电图和24h动态心电图证实的持续30s以上症状性心房颤动复发。比较治疗后窦律维持率及治疗前和治疗后3、6、9、12月左心房内径。结果在12月的随访期中,Ⅰ、Ⅱ、Ⅲ、Ⅳ组分别有9例(23.1%),8例(22.2%),16例(43.2%),16例(45.7%)到达一级终点(P<0.01),无论心功能异常程度,联合治疗窦律维持率均高于单用胺碘酮组(均P<0.05),联合用药组心功能异常的2个组间及单用胺碘酮2个组间对窦律维持率差异无统计学意义(P>0.05)。单用胺碘酮组心房内径显著大于联合组(P<0.05)。结论厄贝沙坦联合胺碘酮对不同心功能状态下PAF窦律维持效果均优于单用胺碘酮,并能延缓左房扩大;但对心功能轻度异常及心功能明显异常者窦性心律维持率无差异。Objective To evaluate the effect of irbesartan plus amiodarone as compared with amiodarone monotherapy in maintaining sinus rhythm in paroxysmal atrial fibrillation （PAF） patients with mild or severe cardic dysfunction. Methods One hundred and forty seven patients with PAF were treated with one of follwing drug or drugs combination： 76 patients with mild cardic dysfunction were treated with irbesartan （150 mg/d） plus amiodarone （600 mg/d, group Ⅰ , n=39） or amiodarone alone （600 mg/d, group Ⅲ,n=37） , 71 severe cardic dysfunction patients received irbesartan （150 mg/d） plus amiodarone （600 mg/d, group Ⅱ, n = 36） or amiodarone alone （600 mg/d, group Ⅳ, n= 35） treatment. The irbesartan and amiodarone treatment administration was gradually increased or decreased according to routine regimen. The end-point was the sympomatic recurrence of atrial fibrillation （AF） sustained over 30 seconds detected by 12 curves ECG and Holter monitor. The sinus rhythm maintenance rate and left atrium diameter at the 3^rd , 6^th , 9^th , 12^th month after treatment were compared. Results During the 12 months follow-up, the recurrence rates were 23.1%, 22.2%, 43.2%, 45.7% in 4 groups respectively （all P〈0.01 ）. 12 months after treatment, the maintenance rate of sinus rhythm in 2 groups treated with amiodarone alone were significantly lower than 2 groups of combined treatment （both P〈0.01）, associated with greater left atrial diameter （both P〈0.05）. Conclusion The combination of irbesartan with amiodarone were superiore to amiodarone alone in decreasing the rate of AF recurrence and inhibiting enlargement of left atrium in patients with PAF irrespective with cardic function.

关 键 词：阵发性心房颤动 厄贝沙坦 胺碘酮 

分 类 号：R541.75[医药卫生—心血管疾病] R581.1[医药卫生—内科学]