缬沙坦联合胺碘酮治疗原发性高血压伴阵发性心房颤动患者的效果观察
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摘要
目的观察缬沙坦联合胺碘酮对原发性高血压(EH)伴阵发性心房颤动(PAF)患者复律后P波离散度(Pd)、最大P波时限(Pmax)、左心房内径(LAD)、超敏C反应蛋白(hs-CRP)及窦性心律维持率的影响,探讨缬沙坦预防心房颤动的作用机制。方法 83例EH伴PAF患者,随机分为治疗组(44例,常规降压药物+缬沙坦+胺碘酮治疗)及对照组[39例,除血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体阻滞剂(ARB)类药物外的常规降压药物+胺碘酮治疗],观察两组患者治疗前及治疗12个月后Pd、Pmax、hs-CRP、LAD的变化及窦性心律维持情况。结果治疗12个月后两组Pd、Pmax、LAD、hs-CRP水平均低于本组治疗前,且治疗组均低于对照组,差异均具有统计学意义(P<0.05)。治疗组窦性心律维持率85.7%显著高于对照组64.9%,差异具有统计学意义(P<0.05)。结论缬沙坦联合胺碘酮治疗EH伴PAF能够有效维持窦性心律,部分预防心房颤动发生,可能与其降低hs-CRP水平,减小Pd、Pmax、LAD有关。
Objective To observe the effect of valsartan combined with amiodarone on P wave dispersion(Pd), maximum P wave duration(Pmax), left atrial diameter(LAD), high sensitive C reactive protein(hsCRP) and maintenance rate of sinus rhythm after cardioversion of patients with essential hypertension(EH) complicated with paroxysmal atrial fibrillation(PAF), and discuss the mechanism of valsartan in preventing atrial fibrillation. Methods A total of 83 patients with EH and PAF were randomly divided into treatment group(44 cases, conventional antihypertensive drugs + valsartan + amiodarone) and control group [39 cases, conventional antihypertensive drugs + amiodarone in addition to angiotensin converting enzyme inhibitors(ACEI) and angiotensin Ⅱ receptor blockers(ARB) drugs]. Observation were made on changes of Pd, Pmax, hs-CRP and LAD before treatment and after 12 months of treatment and maintenance rate of sinus rhythm between two groups. Results After 12 months of treatment, both groups had lower Pd, Pmax, hs-CRP and LAD level than before treatment, and the treatment group was lower than the control group, and the difference was statistically significant(P<0.05). The treatment group had obviously higher maintenance rate of sinus rhythm(85.7%) than the control group(64.9%), and the difference was statistically significant(P<0.05). Conclusion Combination of valsartan and amiodarone can effectively maintain sinus rhythm for the treatment of EH complicated with PAF and partially prevent the occurrence of atrial fibrillation, which may be associated with its lower hs-CRP levels, reducing Pd, Pmax, LAD.
Objective To observe the effect of valsartan combined with amiodarone on P wave dispersion(Pd), maximum P wave duration(Pmax), left atrial diameter(LAD), high sensitive C reactive protein(hsCRP) and maintenance rate of sinus rhythm after cardioversion of patients with essential hypertension(EH) complicated with paroxysmal atrial fibrillation(PAF), and discuss the mechanism of valsartan in preventing atrial fibrillation. Methods A total of 83 patients with EH and PAF were randomly divided into treatment group(44 cases, conventional antihypertensive drugs + valsartan + amiodarone) and control group [39 cases, conventional antihypertensive drugs + amiodarone in addition to angiotensin converting enzyme inhibitors(ACEI) and angiotensin Ⅱ receptor blockers(ARB) drugs]. Observation were made on changes of Pd, Pmax, hs-CRP and LAD before treatment and after 12 months of treatment and maintenance rate of sinus rhythm between two groups. Results After 12 months of treatment, both groups had lower Pd, Pmax, hs-CRP and LAD level than before treatment, and the treatment group was lower than the control group, and the difference was statistically significant(P<0.05). The treatment group had obviously higher maintenance rate of sinus rhythm(85.7%) than the control group(64.9%), and the difference was statistically significant(P<0.05). Conclusion Combination of valsartan and amiodarone can effectively maintain sinus rhythm for the treatment of EH complicated with PAF and partially prevent the occurrence of atrial fibrillation, which may be associated with its lower hs-CRP levels, reducing Pd, Pmax, LAD.
引文
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[8]卢志坚.胺碘酮联合缬沙坦治疗阵发性房颤61例疗效观察.吉林医学,2010,31(10):1376-1377.
[9]程鹏,张雄燕,段建华.缬沙坦联合胺碘酮对高血压合并阵发性心房颤动患者维持窦性心律的干预.浙江中医药大学学报,2009,33(3):398.
[10]朱晓东,董金虎,郭施勉,等.胺碘酮联合缬沙坦治疗阵发性房颤54例疗效观察.中国医药指南,2012,10(8):523-524.
[2]黄明方,刘经南,盖晓波,等.缬沙坦改善高血压房颤患者血管内皮功能.中华高血压杂志,2007,15(2):151-154.
[3]Cheneau E,Rha SW,Kuchulkanti PK,et al.Impact of sirolimus eluting stents on outcomes of patients treated for acudte myocardial infarction by primary angioplasty.Catheter Cardiovasc Interv,2005,65(4):469-472.
[4]郭继鸿,胡大一.中国心律学.北京:人民卫生出版社,2009:472-508.
[5]Rodriguez AE,Mieres J,Femandez-Pereira C,et al.Coronary stent thrombosis in the current drug-eluting stent era:insights from the ERACⅢtrial.J Am Coll Cardiol,2006,47(1):205-207.
[6]Mclrid AH,Escobar C,Rellb JM,et al.Angiotensin receptorblockar as adjunctive therapy for rhytm control in atrial fibrillation;results of the irbesartan amiodrone trial.Gard Electrophysiol Rev,2003,7(3):242-245.
[7]Healey JS,Baranchuk A,Crystal E,et al.Prevention of atrial fibrillation with angiotensin converting enzyme inhibitors and angiotensin receptor blockers:a meta-analysis.J Am Coll Cardiol,2005,45(11):1832-1839.
[8]卢志坚.胺碘酮联合缬沙坦治疗阵发性房颤61例疗效观察.吉林医学,2010,31(10):1376-1377.
[9]程鹏,张雄燕,段建华.缬沙坦联合胺碘酮对高血压合并阵发性心房颤动患者维持窦性心律的干预.浙江中医药大学学报,2009,33(3):398.
[10]朱晓东,董金虎,郭施勉,等.胺碘酮联合缬沙坦治疗阵发性房颤54例疗效观察.中国医药指南,2012,10(8):523-524.