联合用药对阵发性心房颤动患者疗效观察

The effect of drug combination on patients with paroxysmal atrial fibrillation

目的 观察联合应用小剂量胺碘酮、螺内酯与厄贝沙坦对非瓣膜病阵发性心房颤动患者窦性心律的维持,对左心房内径、脑钠肽以及安全性的影响.方法 将142例非瓣膜病阵发性心房颤动按就诊顺序随机分为胺碘酮组（n=47）,胺碘酮加螺内酯组（n=47）,胺碘酮、厄贝沙坦、螺内酯组（联合用药组,n=48）,3组均服用胺碘酮,胺碘酮加螺内酯组在应用胺碘酮基础上加用螺内酯,联合用药组在应用胺碘酮、螺内酯基础上加用厄贝沙坦,观察3组治疗6、12、18个月后的左心房内径、脑钠肽变化以及治疗3、6、12、18、24个月后的窦性心律维持率和安全性.结果 治疗6个月后3组左心房内径、脑钠肽值差异无统计学意义,但12个月后胺碘酮加螺内酯组、联合用药组的左心房内径、脑钠肽值明显小于胺碘酮组（P＜0.05）,联合用药组左心房内径、脑钠肽值明显小于胺碘酮加螺内酯组（P＜0.05）;治疗3、6个月后胺碘酮组窦性心律维持率低于胺碘酮加螺内酯组、联合用药组,治疗6个月后胺碘酮组和联合用药组之间差异有统计学意义（P＜0.05）,治疗12个月后胺碘酮加螺内酯组、联合用药组的窦性心律维持率明显大于胺碘酮组（P＜0.05）,联合用药组窦性心律维持率明显大于胺碘酮加螺内酯组（P＜0.05）.结论 胺碘酮、螺内酯联合治疗非瓣膜病阵发性心房颤动维持实性心律的疗效优于单用胺碘酮,并能延缓左心房的扩大和脑钠肽值的升高,在胺碘酮、螺内酯基础上加用厄贝沙坦则使上述疗效进一步加强.

Objective To observe the effect and safety of amiodarone, spironolactone and irbesartan on sinus rhythm, left atrial internal diameter and brain natruretic peptide（BNP） for patients with nonvalvular paroxysmal atrial fibrillation（AF）. Methods One hundred and forty-two patients with nonvalvular paroxysmal atrial fibrillation were divided into amiodarone group（n=47）, amiodarone plus spironolactone group （n = 47 ） and amiodarone spironolactone plus irbesartan group （ Combined treatment group, n = 48 ）. Three groups were treated with amiodarone.Amiodarone plus spironolactone group was treated with spironolactone in addition. Combined treatment group was treated with irbesartan based on amiodarone and spironolactone. Left atrial internal diameter and BNP were observed after 6 months, 12 months, 18 months respectively and the rate of maintenance of sinus rhythm was observed after 3months, 6 months, 12 months, 18 months, 24 months respectively. The safety of drugs was observed during this study. Results After 6 months treatments, left atrial internal diameter and BNP of three groups was no difference but left atrial internal diameter and BNP of amiodarone plus spironolactone group and Combined treatment group was less than that of amiodarone group after 12 months （ P 〈 0.05 ）. left atrial internal diameter and BNP of combined treatment group was less than those of amiodarone plus spironolactone group after 12 months （ P 〈 0.05 ）. After 3and 6 months treatments, the rate of maintenance of sinus rhythm of amiodarone group was lower than that in amiodarone plus spironolactone group and combined treatment group, but there was no statistically significance difference between amiodarone group and amiodarone plus spironolactone group, amiodarone plus spironolactone group andCombined treatment group. The rate of maintenance of sinus rhythmia of amiodarone group was statistically lower than that in combined treatment group （P〈0.05）. After 12 months, The rate of mainterance of sinus rhythmia of amiodarone plus spironolactone group and Combined treatment group was more than that of amiodarone group （P〈0.05 ）, and that of group Ⅲ was more than that of amiodarone plus spironolactone group （ P 〈 0.05 ）. Conclusions Therapeutic results of mainterance of sinus rhythmia is better with amiodarone plus spironolactone than with amiodarone lonely, and treatment with amiodarone plus spironolactone can suspend the enlargement of left atrial. This influence will strengthen if treated with irbesartan based on amiodarone and spironolactone.