缬沙坦治疗高血压伴阵发性心房颤动的临床观察(1)
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[摘要] 目的:观察高血压伴有阵发性心房颤动(AF)的患者应用缬沙坦在AF复律后维持窦性心律的疗效。方法:选择2007年6月～2008年12月沈阳市红十字会医院心内科80例高血压伴有阵发性AF患者,AF转复后随机将其分为两组,在口服胺碘酮的基础上,对照组40例给予常规降压药物[除外血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ拮抗剂(ARB)类药物],治疗组40例给予缬沙坦降压,1个疗程观察18个月。结果:治疗组左房内径明显小于对照组,窦性心律维持率明显高于对照组,结果差异有统计学意义。结论:胺碘酮联合应用缬沙坦治疗高血压伴阵发性AF可在降低血压的同时有效维持窦性心律。
[关键词] 缬沙坦;高血压;心房颤动;心房重构;窦性心律
[中图分类号] R972 [文献标识码]B [文章编号]1674-4721(2010)05(a)-053-02
The clinical observation of treating hypertension with paroxysmal auricular fibrillation with Valsartan
GAO Mingjie,WU Tianbing
(Red Cross Hospital of Shenyang City, Liaoning Province, Shenyang 110013, China)
[Abstract] Objective: To investigate the efficacy treating hypertension with paroxysmal auricular fibrillation with Valsartan. Methods: 80 cases of hypertension and paroxysmal auricular fibrillation patients were divided into two groups after cardioversion from June 2007 to Deceber 2008. The control group(40 cases)were treated by amiodarone and commonly used antihypertensive drugs(except ACEI and ARB). The treatment group were treated by amiodarone and antihypertensive drugs contained Valsartan.The course of treatment was 18 months. Results: The LAD of treatment group were narrower than that of control group's, and Sinus rhythm maintenance rate was higher than that of control group's. Conclusion: It can be an effective way to decrease blood pressure and maintain the Sinus rhythm treated by amiodarone combined with valsartan for hypertension with paroxysmal auricular fibrillation.
[Key words] Valsartan; Hypertension; Paroxysmal auricular fibrillation; Atrial remodeling; Sinus rhythm
缬沙坦作为血管紧张素Ⅱ拮抗剂(ARB)具有高度血管紧张素Ⅱ1型(AT1)受体特异的选择性,可阻滞多种血管紧张素Ⅱ介导的有害效应。现已广泛引用于治疗高血压,但用于治疗心律失常的较少。有研究证实,心房颤动(AF)是心房电重构与结构重构的结果。而电重构与结构重构的发生与肾素血管紧张素系统(RAS)的激活密切相关[1]。长期高血压会导致心脏重构和心房重构,两者均可使房颤易于诱发和持续。近年试验研究发现ARB通过血管紧张素系统作用,防止心房重构可能有预防AF发生的作用[2]。应用小剂量胺碘酮治疗房颤复律及复律后维持窦性心律的效果报道不一。本研究应用ARB与胺碘酮合用对高血压并发AF患者的房颤复律及复律后窦性心律维持进行观察,现将结果报道如下:
1 资料与方法
1.1 一般资料
选择2007年6月～2008年12月高血压伴阵发性AF患者80例,年龄(42.7±7.2)岁,男49例,女31例。入选患者均符合以下标准:①24 h心电图记录有阵发性AF发作;②心功能均为Ⅰ~Ⅱ级(NYAH分级);③血压控制良好,收缩压<140 mmHg和(或)舒张压<90 mmHg(1 mmHg=0.133 kPa),且未服用血管紧张素转换酶抑制剂(ACEI)和ARB类降压药物 ......
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