摘要
目的探讨醛固酮受体拮抗剂(螺内酯)在心房颤动恢复窦性心律后预防其复发,对窦性心律有效性的维持以及对心房重构的影响。方法 80例持续性房颤患者(持续超过7天),经药物或电复律后随机分为两组,对照组40例给予胺碘酮0.2 g,每日1次,治疗组40例给予胺碘酮0.2 g,每日1次,醛固酮受体拮抗剂螺内酯40 mg,1次/日,两组均连续服用6个月。于治疗后第1周、2周、1月、2月、4月及6月分别行心电图或HOLTER以检测是否存在房颤复发;复律次日及6月后做超声心动图检查,观察左心房结构及功能变化。随访6个月,观察研究前后血浆醛固酮(aldosterone,Ald)浓度。结果 80例均完成治疗,随访6月,心房颤动复发率对照组32.5%,治疗组12.5%,两组间比较有统计学意义(P<0.05)。治疗组心房颤动转复6月后患者左心房内径缩小,左房射血分数(LAEF)增高。治疗前后比较差异有统计学意义(P<0.05);对照组患者治疗前、治疗后比较差异无统计学意义(P>0.05)。结论持续性心房颤动复律后,为了维持窦性心律,联合应用胺碘酮、螺内酯较单独应用胺碘酮更加有效,螺内酯的长期服用可缩小扩大的左房,左房压力降低,对肾素-血管紧张素-醛固酮系统激活的抑制可改善心房重构,预防房颤反复复发。
Objective To evaluate the efficacy of Aldosterone antagonist in maintenance of sinus rhythm after cardiover- sion of atrial fibril lation and its influence on atrial function. Methods 80 patients with persistent atrial fibril lation were randomly divided into two groups, after cardioversion using either antiarrhythmie medicines or synchronized direct current. Two groups of patients were compared. Control group was treated with amiodarone 0. 2 g daily for 6 month, management group was treated with amiodarone 0.2 g daily plus Aldosterone antagonist （Spironolaetone） 40 mg daily in the same pe- riod. During 6 month of follow - up, electrocardiogram and 24 - hour holter recording were performed for detection of re- currence of AF in the first week, second week, first month, second month, fourth month and sixth month. The echocar- diography examinations were performed on the next day and six months after eardioversion to evaluate changes in left atri- al structure and function. Results After 6 month of follow - up , there were 32. 5% AF recurrence of control group while 12. 5% with AF recurrence of management group. There was a significant difference between the two groups （P 〈 0. 05 ）, the left atrial diameter （LAD, mm） measured by echocardiography on the next day and six months after cardio- version in management group was reduction （ P 〈 0.05 ） , while in control group, LAD did not show any significant reduc- tion after six months （P 〉 0.05 ）. Conclusions Combination of Aldosterone antagonist and amiodarone is more effective in maintenance of sinus rhythm after cardioversion of AF than amiodarone alone. Long term treatment of Aldosterone an- tagonist may reverse LA enlargement, decrease LA pressure and prevent the recurrence of AF.
出处
《航空航天医学杂志》
2013年第12期1450-1452,共3页
Journal of Aerospace medicine
关键词
醛固酮受体拮抗剂
心房颤动
心房重构
aldosterone antagonists
atrial fibrillation
atrial remodeling
