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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 compare the efficacy of irbesartan with amiodarone and amiodarone alone in maintenance of sinus rhythm (sinus rhythm) in patients with mild abnormal cardiac function and abnormal cardiac function in patients with paroxysmal atrial fibrillation (PAF). Methods 147 patients with PAF were randomly divided into irisartan (150mg / d) plus amiodarone combination therapy (600mg / d) for mild dysfunction group (group Ⅰ, n = 39) (N = 36, n = 36); single cardiac dysfunction with amiodarone (n = 37); and cardiac function abnormal group (n = 35 ), Treatment follow-up time of one year. The endpoint of the study was 12-lead electrocardiogram and 24-hour ambulatory electrocardiographic evidence of recurrence of symptomatic atrial fibrillation lasting more than 30 seconds. The maintenance rate of sinus rhythm after treatment was compared with that of left atrium before treatment and 3, 6, 9 and 12 months after treatment. Results In the follow-up period of December, there were 9 cases (23.1%), 8 cases (22.2%), 16 cases (43.2%) and 16 cases (45.7% P <0.01). The maintenance rate of sinus rhythm was significantly higher than that of the single amiodarone group (both P <0.05) regardless of the degree of cardiac dysfunction. The two groups with cardiac dysfunction in combination group and amiodarone alone No significant difference was found between the two groups in the maintenance of sinus rhythm (P> 0.05). Atrial amiodarone alone group was significantly larger than the combined group (P <0.05). Conclusions Irbesartan combined with amiodarone can maintain the sinus rhythm of PAF under different cardiac function states better than amiodarone alone and delay the enlargement of the left atrium. However, the effect of irbesartan and amiodarone on the maintenance of sinus rhythm in patients with mild cardiac dysfunction and abnormal cardiac function There was no difference in maintenance of sexual rhythm.