胺碘酮联合厄贝沙坦对心力衰竭合并心律失常的疗效及机制研究

目的：探讨胺碘酮联合厄贝沙坦对心力衰竭合并心律失常的临床疗效，观察其对心功能的影响及其作用机制。方法选择该院2013年9月至2014年11月慢性心力衰竭合并心律失常患者124例，分为对照组和观察组，两组各62例，对照组在常规治疗基础上应用胺碘酮治疗，观察组应用胺碘酮联合厄贝沙坦治疗。治疗6个月后评估两组患者临床疗效，观察患者在1、3、6个月后窦性心律维持情况，应用超声心动图评估心功能[每搏心输出量（SV）、左室射血分数（LVEF）、左心室收缩末期内径（LVESD）及左心室舒张末期内径（LVEDD）]并观察不良反应。结果观察组显效率为88．71％（55／62），高于对照组[62．90％（39／62）]，差异有统计学意义（P＜0．05）；观察组患者在1、3、6个月后窦性心律维持率分别74．19％（46／62）、85．48％（53／62）和67．74％（42／62），均高于对照组[54．84％（34／62），64．52％（40／62），58．06％（36／62）]，差异有统计学意义（P＜0．05）；观察组治疗后 SV 和 LVEF 分别为（4．69±0．31） L ／min 和（50．31±1．20）％，均高于对照组治疗后的（4．22±0．30）L ／min 和（45．61±0．96）％，差异有统计学意义（P ＜0．05），两组治疗后 SV 、LVEF 均高于治疗前，差异有统计学意义（P ＜0．05）；观察组治疗后LVESD 和 LVEDD 分别为（51．13±3．16）mm 和（56．20±3．24）mm ，均低于对照组治疗后的（55．08±3．03）mm 和（60．03±3．15） mm ，两组治疗后 LVESD 和 LVEDD 均低于治疗前，差异有统计学意义（P＜0．05）；两组不良反应率比较，差异无统计学意义（P＞0．05）。结论胺碘酮联合厄贝沙坦对心力衰竭合并心律失常具有较好的临床疗效，能够显著提高患者窦性心律维持率，改善患者心功能，具有较高的安全性。

Study on effect and mechanism of amiodarone combine with irbesartan on arrhythmia patients with heart failure

Objective To explore the clinical effect of amiodarone combine with irbesartan on arrhythmia patients with heart failure ,to observe its effect on cardiac function and its mechanism .Methods 124 patients with chronic heart failure combine with arrhythmia were selected in the hospital from September 2013 to November 2014 ,they were randomly divided into the control group and the observation group ,62 patients in each group .The control group was treated with amiodarone on the basis of routine thera-py ,the observation group was treated with amiodarone combine with irbesartan .The clinical efficacy of the two groups were as-sessed after treated 6 months ,the maintenance of sinus rhythm were observed after 1 ,3 and 6 months .By ultrasound heartbeat to assess heart function :cardiac stroke volume (SV) ,left ventricular ejection fraction (LVEF) ,left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) ,and to observe the adverse reactions .Results The efficiency rate of the observation group was 88 .71% (55/62) ,higher than that of the control group 62 .90% (39/62) ,the difference was statistically significant (P< 0 .05) .The maintenance rate of sinus rhythm after 1 ,3 and 6 months in observation group were 74 .19% (46/62) , 85 .48% (53/62) and 67 .74% (42/62) ,respectively ,higher than those of the control group[54 .84% (34/62) ,64 .52% (40/62) , 58 .06% (36/62)] ,the difference was statistically significant(P < 0 .05) .After treatment ,SV and LVEF of the observation group were (4 .69 ± 0 .31)L/min and (50 .31 ± 1 .20)% ,respectively ,higher than those of the control group (4 .22 ± 0 .30)L /min and (45 . 61 ± 0 .96)% ,SV and LVEF of two groups after treatment were higher than those of before treatment ,the difference was statisti-cally significant (P< 0 .05) .After treatment ,LVESD and LVEDD of the observation group were (51 .13 ± 3 .16)mm and (56 .20 ± 3 .24)mm ,respectively ,lower than those of the control group [(55 .08 ± 3 .03)mm and (60 .03 ± 3 .15)mm] ,LVESD and LVEDD of two groups after treatment were lower than those of before treatment ,the difference was statistically significant (P< 0 .05) .Com-pared the adverse reactions rate ,there was no statistically significant difference between the observation group and the control group (P> 0 .05) .Conclusion Amiodarone combine with irbesartan has good clinical efficacy in the treatment of heart failure combine with arrhythmia ,the maintenance rate of sinus rhythm can be significantly enhanced ,and improve heart function ,it has a higher se-curity .