螺内酯对肺源性心脏病合并快速型房性心律失常的疗效

Effects of spironolactone on rapid atrial arrhythmia in patients with pulmonary heart disease

目的观察应用不同剂量螺内酯治疗慢性肺源性心脏病(PHD)患者前后右心重构、肺功能以及快速型房性心律失常发生率的变化情况。方法选取2015年9月至2017年2月惠州市第三人民医院就诊的慢性阻塞性肺疾病(COPD)合并PHD患者90例作为研究对象,随机分成对照组、研究A组及研究B组,每组30例。对照组依据GOLD指南给予常规治疗,研究A组在对照组基础上加用螺内酯20 mg/d口服,研究B组加用螺内酯40 mg/d口服,治疗6个月时复查右房内径(RAD)、肺动脉压力(PAP)、Tei指数、左房内径(LAD)、左室射血分数(LVEF)、肺活量(FVC)、第一秒用力呼气容积(FEV1)、最大呼气流量(PEF)等指标,并记录心律失常情况。结果治疗6个月时,研究A组的RAD为(48.0±8.2)mm、PAP(29.5±3.5)mm Hg、Tei指数(0.62±0.11)、LAD(28.1±6.0)mm,FVC(80.3±8.6)、FEV1(78.5±12.8)、PEF(76.8±10.9),研究B组的相关指标顺次为(47.3±9.2)mm、(29.8±3.6)mm Hg、(0.58±0.16)、(28.3±7.8)mm、(83.9±9.1)、(81.4±13.1)、(80.9±9.8),均较对照组明显改善,差异有统计学意义(P<0.05);治疗前对照组、研究A组及研究B组存在快速型房性心律失常分别为15例(50.0%)、16例(53.3%)及14例(46.7%),治疗后依次为17例(56.7%)、9例(30.0%)、7例(23.3%),B组心律失常的发生率较对照组降低,差异有统计学意义(P<0.05)。结论螺内酯在一定程度上能改善慢性PHD患者右心重构及肺功能,并降低快速型房性心律失常的发生率,但不同剂量的治疗效果尚不确切。

Objective To study the effect of spironolactone on the change of the right heart remodeling,pulmonary function and the incidence of rapid atrial arrhythmia in the patients with chronic pulmonary heart disease（PHD）.Methods 90 cases of patients with PHD who were treated in the Third People′ s Hospital of Huizhou between September 2015 and February 2017 were selected as study subjects and were randomized into the control group,research group A and research group B,30 cases in each group.The control group was treated with conventional therapy;the research group A was treated with conventional therapy plus spironolactone 20 mg/d and the research group B was treated with conventional therapy plus spironolactone 40 mg/d.The inner diameter of the right atrium diameter（RAD）,the pulmonary artery pressure（PAP）,Tei index,left atrium diameter（LAD）,left ventricular ejection fraction（LVEF）,the forced vital capacity（FVC）,the forced expiratory volume in one second（FEV1）and the peak expiratory flow（PEF） were reviewed for 6 months.Meanwhile,all cases were needed to record arrhythmia.Results At 6 month,compared with the control group,the RAD（48.0±8.2）mm,PAP（29.5±3.5）mm Hg,Tei index（0.62±0.11）,LAD（28.1±6.0）mm,FVC（80.3±8.6）,FEV1（78.5±12.8）and PEF（76.8±10.9）in research group A were significantly improved.The above indicators in research group B were（47.3±9.2）mm,（29.8±3.6）mm Hg,0.58±0.16,（28.3±7.8）mm,83.9±9.1,81.4±13.1 and 80.9±9.8,respectively.The differences were significant（P〈0.05）.15 cases（50.0%）in control group,16 cases（53.3%）in research group A and 14 cases（46.7%）in research group B recorded rapid atrial arrhythmia before the treatmnet,However,atrial arrhythmia recurrence were 17 cases（56.7%）,9 cases（30.0%）and 7 cases（23.3%）,respectively at 6 month;the rate of atrial arrhythmia in the research groups was significantly lower than that in the control group（P〈0.05）.Conclusion To a certain extent,spironolactone could improve the right heart remodeling and pulmonary function in patients with chronic pulmonary heart disease,meanwile it could reduce the incidence of rapid atrial arrhythmia,but the required therapeutic doses needed further investigation.