氯沙坦及胺碘酮联合应用对减少原发性高血压合并心房颤动复发.docVIP

氯沙坦与胺碘酮联合应用对减少原发性高血压合并心房颤动复发 　　作者：王焱,陈灿,黄石安　　作者单位：广东医学院附属医院心血管内科，广东湛江 524001 　　【摘要】目的 探讨血管紧张素Ⅱ受体拮抗剂氯沙坦与抗心律失常药物胺碘酮联合应用是否可以减少原发性高血压合并心房颤动的复发。方法 将原发性高血压合并持续性或阵发性房颤经电转复或药物恢复窦性心律的178例患者随机分为氯沙坦组与氨氯地平组，每组89例。两组恢复窦律后均选用胺碘酮维持窦律，氯沙坦组以氯沙坦100～150 mg/d作为基础用药，氨氯地平组以氨氯地平5～10 mg/d作为基础用药，疗程为1a。观察两组患者1a内的房颤复发率并比较治疗前后左心房内径(LAD)、左房舒张末期容量(LAEDV)、左房收缩末期容量(LAESV)及左心房射血分数(LAEF)。结果 氯沙坦组房颤复发率比氨氯地平组明显降低(16.9% vs 32.6%，P0.05)。治疗后氯沙坦组LAD 、LAEDV及LAESV较治疗前有明显下降(P0.01);氨氯地平组则无明显改善。两组治疗后的LAEF均明显增加，且以氯沙坦组增加更为显著(P0.01)。结论 氯沙坦能够逆转原发性高血压引起的左室肥厚，可以延缓左心房扩大，进而改善心房的电重塑与结构重塑，从而减少原发性高血压合并房颤的复发。 　　【关键词】 心房颤动,氯沙坦,胺碘硐,窦性心律 　　Abstract: Objective To observe whether the combined use of losartan and amiodarone could reduce the recurrence of atrial fibrillation (AF) in essential hypertension (EH).Methods A total of 178 patients with EH and persistent or paroxysmal AF undergoing sinus rhythm (SR) control by electrical conversion or drugs were randomly divided into losartan group (100～150 mg/d，n=89) and amlodipine group (5～10 mg/d，n=89). Amiodarone were administered to maintain SR in both groups. AF recurrence, left atrial dimension (LAD), left atrial enddiastolic volume (LAEDV), left atrial endsystolic volume (LAESV) and left atrial ejection fraction (LAEF) were compared between two groups after 1 year.Results AF recurrence, LAD, LAEDV and LAESV improved obviously in losartan group (P0.01 or 0.05) compared with amlodipine group. LAEF increased remarkably in both groups, especially in losartan group (P0.01).Conclusion Losartan may reduce the recurrence of AF in patients with EH by reversing the left ventricular hypertrophy, delaying the left atrial enlargement, and improving atrial electric and structural remodeling. 　　Key words: atrial fibrillation; losartan; amiodarone; sinus rhythm 　　心房纤颤(房颤)是常见的快速性心律失常，随年龄增加其发病率逐渐增加[1]。房颤可降低心脏功能，减低患者生活质量，是导致脑中风及外周动脉栓塞的重要原因，大部分患者都可以通过抗心律失常药物和(或)电复律来获得治疗。但是，由于电重构和(或)结构重构的存在，房颤的复发率仍然很高。高血压是导致房颤最主要因素之一，两者均与肾素血管紧张素系统活跃有关。血管紧张素受体拮抗剂已广泛应用于高血压治疗，但极少涉及心律失常治疗。近年动物实验研