常用控制心室率药物的随机对照研究

VENTRICULAR RATE CONTROL IN CHRONIC ATRIAL FIBRILLATION: A RANDOM STUDY OF FIVE DRUG REGIMENS

目的 :比较五种常用药物组合对慢性房颤患者静息及活动状态下心室率的控制作用。方法 :顺序住院的 6 0例慢性心房纤颤患者由不参与研究者随机分为五组 ,即A组 :单用地高辛 0 2 5mg d ;B组 :单用倍它乐克 5 0mg d ;C组 :单用异搏定 (缓释制剂 ) 2 40mg d ;D组 :0 2 5mg地高辛与 5 0mg倍它乐克联用 ;E组 :0 2 5mg地高辛与 2 40mg异搏定 (缓释制剂 )联用。每组 12例。统计处理用ANOVA、非参数统计、χ2 检验及配对t检验等方法。结果 :地高辛与倍它乐克联用组的心室率明显低于地高辛单用组 (P =0 0 0 0 )、单用倍它乐克组 (P =0 0 0 2 )和单用异搏定组(P =0 0 0 2 ) ;运动中 ,A组及D组治疗方案分别导致最高和最低的心室率反映 (114 33± 11 46与 10 0 83± 6 49次 min ,P =0 0 2 4) ;D组达到目标心室率所需时间最短 (2 33± 0 49)d ,而A组最长 (7 0 8± 1 93)d ;D组平均住院日短于其他各组 ,但只与A、B两组的差异有统计学意义 ;各治疗组患者心功能获得明显改善 ,但相关无统计学意义。结论 :地高辛单独使用控制心率效果最差 ,倍它乐克和缓释异搏定的疗效相当 ;

Objective: We compared the effects of five pharmacologic regimens on the rest and exercise-induced changes of ventricular rate (VR) of patients with chronic atrial fibrillation (CAF). Methods: In 60 patients (27 male, 45.05+10.89 yr) with CAF, the effects in VR by 5 standardized daily regimens: Group A: 0.25 mg/d Digoxin, Group B: 50 mg/d Betaloc, Group C: 240 mg/d Verapamil-SR, Group D: 0.25 mg Digoxin+50 mg Betaloc and Group E: 0.25 mg Digoxin+240 mg Verapamil-SR, were studied in random order. All data were analyzed by ANOVA, non-parameters test, Chi-square Test and paired t test, respectively. Results: The VR on digoxin+Betaloc was significantly lower than that on digoxin ( P =0.000), Betaloc ( P =0.002) and verapamil-SR ( P =0.002). During exercise, digoxin and digoxin+Betaloc treatment resulted in the highest and lowest mean VR respectively. In the group D, the object VR time is shortest, and the group A is longest. Compared with other group, the average hospital time is shortest in the group D, but significant difference show only compare with group A or group B. Heart function is improvement in all groups, but no significance ( P >0.05). Conclusions: This study indicates as single agents, digoxin is least effective for controlling ventricular rate in atrial fibrillation during rest or activity. For the Betaloc and verapamil, the effective for controlling VR are same. Digoxin+Betaloc produced the most effective rate control reflecting a synergistic effect on the AV node.