厄贝沙坦联合胺碘酮对风湿性心脏病瓣膜置换术后持续性心房颤动转复患者窦性心律维持、心室重构及相关因子影响  

Effects of Irbesartan Combined with Amiodarone on Sinus Rhythm Maintenance,Ventricular Remodeling and Related Factors of Patients with Persistent Atrial Fibrillation after Valve Replacement for Rheumatic Heart Disease

作　　者：王国龙[1] 陈月婷[1] 郭晓曼 WANG Guo-long;CHEN Yue-ting;GUO Xiao-man(Department of Cardiology,Zhuozhou Hospital,Zhuozhou,Hebei 072750,China)

机构地区：[1]涿州市医院心内科,河北涿州072750

出　　处：《临床误诊误治》2021年第5期26-31,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省科技计划项目自筹项目(20180018)。

摘　　要：目的探讨厄贝沙坦联合胺碘酮对风湿性心脏病(RHD)瓣膜置换术后持续性心房颤动转复患者窦性心律维持、心室重构及相关因子的影响。方法选取2018年5月—2019年10月行瓣膜置换术的RHD 118例,根据术后维持窦性心律方法不同将其分为研究组和对照组两组各59例。研究组在常规治疗基础上予厄贝沙坦联合胺碘酮治疗,对照组在常规治疗基础上予胺碘酮治疗,疗程均为12个月。比较两组窦性心律维持情况、心室重构指标、炎性因子、心肌损伤因子及不良反应。结果术后6和12个月,研究组窦性心律维持率均高于对照组,差异有统计学意义(P<0.05)。术后12个月,两组左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)均较术后用药前缩短,左心室收缩末期容量(LVESV)和左心室舒张末期容量(LVEDV)均较术后用药前增大;研究组LVESD和LVEDD短于对照组,LVESV和LVEDV大于对照组,差异有统计学意义(P<0.05或P<0.01)。术后12个月,白细胞介素-4、白细胞介素-8、肿瘤坏死因子-α及N末端脑钠肽前体水平两组均低于术后用药前,且研究组均低于对照组,差异有统计学意义(P<0.01)。治疗期间,两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论厄贝沙坦联合胺碘酮可较好地维持RHD瓣膜置换术后持续性心房颤动转复患者窦性心律,获得最佳心室重构修复效果,减轻炎症反应及心肌损伤,且安全性较好。Objective To investigate effects of Irbesartan combined with Amiodarone on sinus rhythm maintenance,ventricular remodeling and related factors of patients with persistent atrial fibrillation(PAF)after valve replacement for rheumatic heart disease(RHD).Methods A total of 118 RHD patients who had undergone valve replacement during May 2018 and October 2019 were selected and divided into research group(n=59)and control group(n=59)according to different methods of sinus rhythm maintenance after operation.Research group was treated with Irbesartan combined with Amiodarone on the basis of conventional treatment,while control group was treated with Amiodarone on the basis of conventional treatment.The course of treatment was 12 months.Maintenance conditions of sinus rhythm,indexes of ventricular remodeling,inflammatory factors,myocardial injury factors and incidence rates of adverse reactions were compared between two groups.Results Sinus rhythm maintenance rate in research group was higher than that in control group in 6 and 12 months after operation(P<0.05).In 12 months after treatment,values of left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)were lower,while values of left ventricular end systolic volume(LVESV)and left ventricular end diastolic volume(LVEDV)were higher than those after surgeries before medication in two groups;in research group,LVESD and LVEDD values were lower,while LVESV and LVEDV values were higher than those in control group(P<0.05 or P<0.01).In 12 months after treatment,levels of interleukin-4,interleukin-8,tumor necrosis factor-αand N-terminal probrain natriuretic peptide after surgeries before medication in two groups,and the levels in research group were significantly lower than those in control group(P<0.01).There was no significant difference in the total incidence rate of adverse reactions between two groups during the treatment(P>0.05).Conclusion Irbesartan combined with Amiodarone may well maintain sinus rhythm of patients with PAF after va

关 键 词：风湿性心脏病 瓣膜置换术 心房颤动 厄贝沙坦 胺碘酮 心室重构 白细胞介素-4 白细胞介素-8 肿瘤坏死因子-α 

分 类 号：R541.2[医药卫生—心血管疾病]