高血压伴阵发性房颤给予胺碘酮及肾素-血管紧张素-醛固酮系统拮抗剂的疗效观察
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摘要
目的 :探讨高血压伴阵发性房颤给予胺碘酮及肾素-血管紧张素-醛固酮系统拮抗剂治疗的临床效果,以期为临床治疗提供参考。方法 :选择2012年4月-2013年10月我院心内科确诊并收入住院的高血压伴阵发性房颤患者90例,随机分为对照组与试验组,各45例,对照组在常规使用胺碘酮(第1周,200 mg,tid,第2周将用药次数调整为bid,第3周将用药次数调整为qd)的基础上联合依那普利(5~10 mg,bid)治疗,试验组则在胺碘酮(同对照组)基础上联用缬沙坦(80~160 mg,qd)治疗,对两组患者进行为期2年的随访,比较治疗前与随访不同时期两组血压、左心房内径的变化情况与房颤复发情况,同时对两组不良反应情况进行观察。结果 :两组治疗前收缩压(SBP)、舒张压(DBP)均无统计学差异(P>0.05);与治疗前比,随访6个月、1年、2年两组SBP与DBP均明显下降(P<0.05),而组间差异无统计学意义(P>0.05);两组治疗前左心房内径大小无统计学差异(P>0.05),与治疗前比,随访6个月、1年、2年试验组的左心房内径无明显变化(P>0.05),而对照组的左心房内径有明显增大(P<0.05);试验组随访6个月、1年、2年的房颤复发率均显著低于对照组(P<0.05);两组均未见严重不良反应。结论 :高血压伴阵发性房颤应用胺碘酮联合缬沙坦治疗在预防左心房内径增加与房颤复发上效果显著,且安全性较高,具有较高的临床推广价值。
Objective:To investigate the clinical effect of amiodarone and renin-angiotensin-aldosterone system antagonist in the treatment of hypertension patients with paroxysmal atrial fibrillation, so as to provide a guide for clinical practice. Methods:90 cases of hypertension patients with paroxysmal atrial fibrillation diagnosed in department of cardiology in our hospital were selected from April 2012 to October 2013, the patients were randomly divided into the control group and the experimental group, 45 cases in each group. The control group was treated with amiodarone(first weeks, 200 mg, tid; second weeks, 200 mg, bid; third weeks, 200 mg, qd) combined with enalapril(5~10 mg, bid). The experimental group was treated with valsartan(80~160 mg, qd) on the basis of amiodarone(the same as the control group). Followed up for a period of 2 years, the changes of blood pressure, left atrial diameter and recurrence of atrial fibrillation in two groups were compared before treatment and during the follow-up period, and the adverse reactions of the two groups were observed. Results:There were no significant difference in the systolic blood pressure(SBP) and diastolic blood pressure(DBP) between the two groups before treatment(P>0.05). Compared with before treatment, SBP and DBP of two groups were decreased significantly at follow up for 6 months, 1 year and 2 years(P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference in the size of the left atrium between the two groups before treatment(P>0.05), As compared with that before treatment, the left atrial diameter of the experimental group was not significantly changed(P>0.05) while that of the control group was significantly increased(P<0.05) at follow up for 6 months, 1 year and 2 years. The recurrence rate of atrial fibrillation in experimental group was significantly lower than that in control group(P<0.05) at follow up for 6 months, 1 year and 2 years, and there were no serious adverse reactions in the two groups. Conclusion:The application of amiodarone combined with valsartan in the treatment of hypertension patients with paroxysmal atrial fibrillation is effective in preventing the increase of the left atrial diameter and the recurrence of atrial fibrillation, and has high safety and high clinical value.
Objective:To investigate the clinical effect of amiodarone and renin-angiotensin-aldosterone system antagonist in the treatment of hypertension patients with paroxysmal atrial fibrillation, so as to provide a guide for clinical practice. Methods:90 cases of hypertension patients with paroxysmal atrial fibrillation diagnosed in department of cardiology in our hospital were selected from April 2012 to October 2013, the patients were randomly divided into the control group and the experimental group, 45 cases in each group. The control group was treated with amiodarone(first weeks, 200 mg, tid; second weeks, 200 mg, bid; third weeks, 200 mg, qd) combined with enalapril(5~10 mg, bid). The experimental group was treated with valsartan(80~160 mg, qd) on the basis of amiodarone(the same as the control group). Followed up for a period of 2 years, the changes of blood pressure, left atrial diameter and recurrence of atrial fibrillation in two groups were compared before treatment and during the follow-up period, and the adverse reactions of the two groups were observed. Results:There were no significant difference in the systolic blood pressure(SBP) and diastolic blood pressure(DBP) between the two groups before treatment(P>0.05). Compared with before treatment, SBP and DBP of two groups were decreased significantly at follow up for 6 months, 1 year and 2 years(P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference in the size of the left atrium between the two groups before treatment(P>0.05), As compared with that before treatment, the left atrial diameter of the experimental group was not significantly changed(P>0.05) while that of the control group was significantly increased(P<0.05) at follow up for 6 months, 1 year and 2 years. The recurrence rate of atrial fibrillation in experimental group was significantly lower than that in control group(P<0.05) at follow up for 6 months, 1 year and 2 years, and there were no serious adverse reactions in the two groups. Conclusion:The application of amiodarone combined with valsartan in the treatment of hypertension patients with paroxysmal atrial fibrillation is effective in preventing the increase of the left atrial diameter and the recurrence of atrial fibrillation, and has high safety and high clinical value.
引文
[1]裴芳,黄骥,黄婕,等.胺碘酮联合R A S抑制剂治疗高血压合并阵发性房颤的临床研究[J].重庆医学,2014,43(36):4937-4939.
[2]Soon E,Toshner M,Mela M,et al.Risk of potentially lifethreatening thyroid dysfunction due to amiodarone in idiopathic pulmonary arterial hypertension patients[J].J Am Coll Cardiol,2011,57(8):997-998.
[3]朱长友.胺碘酮联合RAS抑制剂治疗高血压合并阵发性房颤的临床研究[J].医学信息,2015,28(36):46.
[4]梅安平.胺碘酮联合厄贝沙坦治疗高血压伴阵发性房颤80例临床观察[J].中国民族民间医药,2015,24(15):95-96.
[5]Novo G,Guttilla D,Fazio G,et al.The role of the reninangiotensin system in atrial fibrillation and the theraqeutic effects of ACE-Is and ARBS[J].Br J Chin Pharmacol,2008,66(3):345-351.
[6]Montero-Pérez FJ.The aqueous formulation of amiodarone i.v.is safer than the formulation available in Spain[J].Medicina clínica,2011,136(1):40.
[7]纪春丽.高血压合并阵发性房颤采用胺碘酮联合R A S抑制剂治疗的临床观察[J].中国卫生标准管理,2015,6(12):67-68.
[8]邓智.缬沙坦联合维拉帕米治疗原发性高血压合并阵发性房颤的临床疗效观察[J].中外医学研究,2013,11(3):13-15.
[9]刘海花.RAS抑制剂与胺碘酮联合治疗高血压合并阵发性房颤的疗效分析[J].中国卫生标准管理,2015,6(11):64-65.
[10]Jurado RA,Rubio AB,Martín AR,et al.Proarrhythmic potential of amiodarone:an underestimated risk[J].Rev Esp Cardiol(Engl Ed.),2012,65(3):292-294.
[11]李亚玲,程亚玲,易全会.替米沙坦联合胺碘酮治疗高血压合并阵发性房颤疗效观察[J].求医问药(学术版),2011,9(6):167-168.
[12]王秀.高血压合并阵发性房颤采用胺碘酮联合R A S抑制剂治疗的临床体会[J].中国继续医学教育,2015,7(19):150-151.
[13]Chan AL,Hsieh HJ,Hsieh YA,et al.Fatal amiodaroneinduced hepatotoxicity:a case report and literature review[J].Int J Clin pharmacol Ther,2008,46(2):96-101.
[14]赵德成,袁建喜.缬沙坦与依那普利对老年高血压患者室性心律失常的影响比较[J].中外医学研究,2014,12(11):1-3.
[15]杨翠兵.胺碘酮联合缬沙坦治疗高血压并阵发性心房颤动患者的临床疗效观察[J].实用心脑肺血管病杂志,2016,24(12):134-135.
[2]Soon E,Toshner M,Mela M,et al.Risk of potentially lifethreatening thyroid dysfunction due to amiodarone in idiopathic pulmonary arterial hypertension patients[J].J Am Coll Cardiol,2011,57(8):997-998.
[3]朱长友.胺碘酮联合RAS抑制剂治疗高血压合并阵发性房颤的临床研究[J].医学信息,2015,28(36):46.
[4]梅安平.胺碘酮联合厄贝沙坦治疗高血压伴阵发性房颤80例临床观察[J].中国民族民间医药,2015,24(15):95-96.
[5]Novo G,Guttilla D,Fazio G,et al.The role of the reninangiotensin system in atrial fibrillation and the theraqeutic effects of ACE-Is and ARBS[J].Br J Chin Pharmacol,2008,66(3):345-351.
[6]Montero-Pérez FJ.The aqueous formulation of amiodarone i.v.is safer than the formulation available in Spain[J].Medicina clínica,2011,136(1):40.
[7]纪春丽.高血压合并阵发性房颤采用胺碘酮联合R A S抑制剂治疗的临床观察[J].中国卫生标准管理,2015,6(12):67-68.
[8]邓智.缬沙坦联合维拉帕米治疗原发性高血压合并阵发性房颤的临床疗效观察[J].中外医学研究,2013,11(3):13-15.
[9]刘海花.RAS抑制剂与胺碘酮联合治疗高血压合并阵发性房颤的疗效分析[J].中国卫生标准管理,2015,6(11):64-65.
[10]Jurado RA,Rubio AB,Martín AR,et al.Proarrhythmic potential of amiodarone:an underestimated risk[J].Rev Esp Cardiol(Engl Ed.),2012,65(3):292-294.
[11]李亚玲,程亚玲,易全会.替米沙坦联合胺碘酮治疗高血压合并阵发性房颤疗效观察[J].求医问药(学术版),2011,9(6):167-168.
[12]王秀.高血压合并阵发性房颤采用胺碘酮联合R A S抑制剂治疗的临床体会[J].中国继续医学教育,2015,7(19):150-151.
[13]Chan AL,Hsieh HJ,Hsieh YA,et al.Fatal amiodaroneinduced hepatotoxicity:a case report and literature review[J].Int J Clin pharmacol Ther,2008,46(2):96-101.
[14]赵德成,袁建喜.缬沙坦与依那普利对老年高血压患者室性心律失常的影响比较[J].中外医学研究,2014,12(11):1-3.
[15]杨翠兵.胺碘酮联合缬沙坦治疗高血压并阵发性心房颤动患者的临床疗效观察[J].实用心脑肺血管病杂志,2016,24(12):134-135.