胺碘酮联合缬沙坦治疗阵发性房颤的疗效观察

目的观察胺碘酮联合缬沙坦治疗阵发性房颤的疗效。方法 62例阵发性房颤患者随机分为2组,治疗组在阵发性房颤发作终止后联用胺碘酮和缬沙坦,对照组单用胺碘酮,观察两组患者维持窦性心律的情况及左心房内径变化情况。结果治疗组患者窦性心律维持率高于对照组,左心房内径较对照组明显缩小。结论胺碘酮联合缬沙坦治疗阵发性房颤能改善心房重构,有利于维持窦性心律,安全有效。目的观察胺碘酮联合缬沙坦治疗阵发性房颤的疗效。方法 62例阵发性房颤患者随机分为2组,治疗组在阵发性房颤发作终止后联用胺碘酮和缬沙坦,对照组单用胺碘酮,观察两组患者维持窦性心律的情况及左心房内径变化情况。结果治疗组患者窦性心律维持率高于对照组,左心房内径较对照组明显缩小。结论胺碘酮联合缬沙坦治疗阵发性房颤能改善心房重构,有利于维持窦性心律,安全有效。     

胺碘酮联合贝那普利治疗阵发性心房颤动疗效观察

目的了解胺碘酮联合贝那普利对阵发性心房颤动复律及复律后窦性心律维持的影响。方法将78例阵发性房颤患者随机分成二组,分别给予胺碘酮、胺碘酮加贝那普利治疗,疗效观察12个月。结果治疗6个月后窦性心律维持及左房内径无统计学意义(P>0.05),治疗12个月后两组窦性心律维持及左心房内径有统计学意义(P<0.05)。结论胺碘酮与贝那普利联合治疗阵发性房颤,维持窦性心律的疗效优于单用胺碘酮,并能延缓左心房扩大。     

胺碘酮联合厄贝沙坦治疗阵发性心房颤动疗效观察

目的观察胺碘酮联合厄贝沙坦治疗阵发性房颤的疗效。方法选择2008年5月～2010年5月期间该院83例阵发性房颤患者,随机分为治疗组(胺碘酮+厄贝沙坦)和对照组(单用胺碘酮),疗程均为一年。结果治疗组窦性心率维持率明显高于对照组(P<0.05),左房内径亦有显著性缩小(P<0.05)。结论厄贝沙坦具有抑制心房电重构和解剖重构,降低房颤复发率及阻止房颤持续的作用,胺碘酮联合厄贝沙坦治疗阵发性心房颤动维持窦性心率的疗效优于单用胺碘酮,且能抑制左房扩大。     

厄贝沙坦联合胺碘酮治疗阵发性房颤的临床疗效

目的 评价胺碘酮联合厄贝沙坦治疗阵发性房颤的临床疗效.方法 78例阵发性房颤的患者随机分为治疗组(胺碘酮+厄贝沙坦)和对照组(胺碘酮),口服给药,疗程均为1年.比较治疗后2组窦性心律维持率和左心房内径的变化.结果 治疗组窦性心率维持率明显高于对照组(P＜0.05),左心房内径亦有显著性缩小(P＜0.05).结论 胺碘酮联合厄贝沙坦治疗阵发性心房颤动维持窦性心率的疗效优于单用胺碘酮,且能抑制左心房扩大.     

福辛普利联合胺碘酮治疗阵发性房颤的疗效观察

目的:评价福辛普利联合胺碘酮治疗阵发性房颤的疗效。方法:选取阵发性房颤复律后患者96例,随机分为治疗组(n=48)和对照组(n=48)。对照组常规口服胺碘酮,治疗组口服胺碘酮加福辛普利,观察两组治疗12个月后的左心房内径及窦性心律维持率。结果:治疗组治疗后的窦性心律维持率明显高于对照组(P<0.05),左心房内径亦较对照组明显缩小(P<0.05)。结论:福辛普利联合胺碘酮治疗阵发性房颤维持窦性心律的疗效优于单用胺碘酮,并能有效延缓左心房的扩大。     

比较胺碘硐、胺碘硐联合氯沙坦对阵发性房颤复发的预防作用

目的：比较胺碘硐及与氯沙坦联用对阵发性房颤患者房颤复发预防的远期效果。方法：85例阵发性房颤,随机分为胺碘硐组（Ⅰ组n=40）和胺碘硐＋氯沙坦组（Ⅱ组n=45）,随访时间为2年,初级终点为房颤复发。比较二组治疗后窦性心律维持率以及6、12、18、24个月的左心房内径。结果：Ⅰ组窦性心律维持率明显低于Ⅱ组,Ⅰ组左心房内径大于Ⅱ组。结论：胺碘硐与氯沙坦联合冶疗阵发性房颤对预防房颤复发优于单用胺碘硐,并抑制左心房扩大。     

厄贝沙坦和胺碘酮联用在房颤复律后维持窦性心律的疗效观察

目的:观察厄贝沙坦和胺碘酮联用在房颤复律后维持窦性心律的疗效。方法:选取我院2001—01～2004—01门诊及住院的持续性房颤患者30例,恢复窦律后随机分为胺碘酮组(13例)和厄贝沙坦 胺碘酮组(17例),胺碘酮组治疗方案:恢复窦性心律后,给予胺碘酮0.2/d一次口服;厄贝沙坦 胺碘酮组在上述方案基础上加厄贝沙坦75～150mmg/d,疗程观察18个月。结果:两组比较厄贝沙坦 胺碘酮组窦性心律维持率高于胺碘酮组。结论:长期服用厄贝沙坦可逆转左房扩大,降低左房压,抑制RAS活性,防止房颤复发。     

胺碘酮联合缬沙坦预防房颤复发及心房重构疗效分析

目的探讨胺碘酮联合缬沙坦预防房颤复发及心房重构的疗效。方法86例阵发性房颤患者随机分为对照组40例与观察组46例,对照组给予胺碘酮口服,观察组接受胺碘酮联合缬沙坦联合治疗1年。比较2组房颤复发率、窦性心律维持率、房颤负荷及左心房内径的改变。结果治疗后3及6个月,2组窦性心律维持率差异无统计学意义（ P ＞0 R．05）,治疗后9个月观察组窦性心律维持率显著高于对照组（ P ＜0．05）;治疗12个月观察组与对照组房颤复发率分别为13．0％和42．5％,差异有统计学意义（ P ＜0．05）;与对照组相比,观察组治疗后12个月左心房内径显著小于对照组（ P ＜0．05）,房颤负荷显著低于对照组（ P ＜0．05）。结论胺碘酮联合缬沙坦能有效地预防阵发性房颤复发,改善心房重构。     

胺碘酮与依那普利联合治疗阵发性心房颤动的临床研究

目的评价胺碘酮与依那普利联合治疗阵发性心房颤动（房颤）的临床疗效。方法将129例阵发性房颤随机分为胺碘酮组（Ⅰ组,n=64）和胺碘酮联合依那普利组（Ⅱ组,n=65）,治疗随访时间为1年,研究终点为房颤发作。比较两组治疗前、治疗后的左心房内径。计算两组治疗后窦性心律维持率。结果两组患者治疗前后左心房内径比较：治疗前分别为（35．21±1．76）mm、（35．84±1．69）mm,治疗后分别为（38．76±2．14）mm、（36．27-I-1．91）mm,治疗后IⅠ组患者左房内径明显小于Ⅰ组。两组患者窦性心律维持率的比较：治疗结束时,Ⅰ组患者窦性心律维持率为62．3％,Ⅱ组患者窦性心律维持率80．6％,两组患者比较有显著性差异。结论胺碘酮与依那普利联合治疗阵发性房颤维持窦性心律的疗效优于单用胺碘酮,对延缓左心房扩大有一定作用。     

心房颤动患者复律后药物维持治疗的临床效果观察

目的观察心房颤动患者复律后药物维持治疗的临床效果。方法选择阵发性心房颤动患者79例,分为胺碘酮治疗组（39例,单纯服用胺碘酮）,联合治疗组（40例,服用胺碘酮及缬沙坦）,随访12个月,观察两组患者治疗前后窦性心律维持率,左房内径的变化。结果治疗12个月后,窦性心律维持率胺碘酮组为64.3%,联合治疗组为81.4%,左房内径胺碘酮组为（40.12±10.6）mm,联合治疗组为（34.10±10.11）mm,P均〈0.05。结论厄贝沙坦联合胺碘酮对阵发性心房颤动复律后维持窦性心律的作用明显优于单用胺碘酮,且明显抑制左房扩大,无明显不良反应。     

雷米普利和替米沙坦与胺碘酮联用治疗阵发性心房颤动的临床观察

目的探讨雷米普利和替米沙坦与小剂量胺碘酮联用对心功能正常的阵发性心房颤动（房颤）维持窦性心律的长期疗效。方法将180例阵发性房颤患者完全随机分为胺碘酮组（A组,61例）、胺碘酮＋雷米普利组（B组,59例）、胺碘酮＋替米沙坦组（C组,60例）,随访2年,比较3组治疗后6、12、18、24个月的窦性心律维持率以及治疗前、后的左心房内径。结果治疗12个月后,A组左心房内径大于B、C组（P〈0．05）,A组窦性心律维持率明显低于B、C组（P〈0．05）。试验终点时,A组的窦性心律维持率为58．62％,B组为77．78％,C组为78．57％（P〈0．05）。结论胺碘酮分别与雷米普利和替米沙坦配伍治疗阵发性房颤维持窦性心律具有相同的疗效,但优于单用胺碘酮,并能抑制左心房的扩大。     

静脉注射胺碘酮治疗心力衰竭伴快速性心房颤动的疗效观察

目的观察心力衰竭伴快速性心房颤动患者静脉注射胺碘酮转复或控制心室率治疗心力衰竭的疗效,包括心房颤动的转复率、转复时间、心室率的控制、不良反应及安全性。方法心力衰竭伴快速性心房颤动患者48例,胺碘酮150mg加50g.L-1葡萄糖注射液20mL静脉注射,患者30min后房颤未转复即再应用1次,继以0.5～1mg.min-1维持静滴48h,观察用药后1,2,6,12,24和48h转复率、心室率、心力衰竭症状的缓解及不良反应。结果胺碘酮可快速有效使快速房颤转复为窦性心律,控制心室率,纠正心力衰竭,且无严重不良反应发生。结论心力衰竭伴快速性心房纤颤患者静脉注射胺碘酮治疗安全有效,尤其适用于合并器质性心脏病患者。     

伊布利特联合胺碘酮治疗心房扑动/心房颤动的疗效观察

目的观察伊布利特联合胺碘酮转复心房扑动（房扑）／心房颤动（房颤）的有效性及安全性。方法选择符合条件的患者88例,按制定的入选标准与排除标准将88例患者根据是否服用胺碘酮分为对照组和试验组。对照组：单用伊布利特;试验组：口服胺碘酮后联合伊布利特。口服胺碘酮组负荷量7～15g（3～4周内达到靶剂量）。伊布利特首剂1．0mg,10min内缓慢静脉注射,如给药10min后仍未转复为窦性心律,行第2次注射,剂量仍为1．0mg,观察开始给药后4h内转复的成功率、转复过程中用药剂量、用药前后的QT间期的差异及4h内不良反应的发生情况。结果①试验组房扑转复成功率（92％）高于对照组（56％）,但差异无统计学意义（P=0．116）;而房颤转复成功率试验组（76％）与对照组（44％）差异有统计学意义（P=0．010）;试验组（80％）与对照组（47％）房扑和房颤总的转复成功率差异亦有统计学意义（P=0．003）。②在转复房扑、房颤成功的患者伊布利特使用剂量房扑[（1．1±0．4）mg]低于房颤[（1．7±0．4）mg],差异有统计学意义（P〈0．01）。③试验组与对照组使用伊布利特前QT间期（0．49±0．08）、（0．43±0．04）差异无统计学意义（P=0．760）;2组使用伊布利特后QT间期（0．52±0．06）、（0．45±0．03）,差异亦无统计学意义（P=0．150）;试验组与对照组各自在注药前后QT间期均延长,差异有统计学意义（对照组P=-0．013;试验组P〈0．01）。④试验组有2例室性心动过速（发生率为2％）。1例在推药过程中发生尖端扭转型室性心动过速（Trip）,经电复律终止,转为窦性心律、频发室性早搏,再次房颤继之再发Tdp,静脉注射2．5g硫酸镁终止;1例在转复成功5min后发生非持续单形性室性心动过速,自行终止。2组各发生2例窦性停搏,均在2-3s后自行或经胸外按压后恢复窦性心律。结论口服胺碘酮联合伊布利特转复房扑,房颤成功率高于单一用药,并可预防其复发,联合应用未增加不良事件的发生率。     

联合用药对阵发性心房颤动患者疗效观察

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.

Abstract：

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.     

氯沙坦联合胺碘酮用于阵发性心房颤动转复后预防复发的临床观察

目的观察氯沙坦和胺碘酮联合应用对阵发性心房颤动转复后复发的影响。方法 59例心房颤动患者随机分为治疗组36例和对照组23例,转复后对照组给予胺碘酮口服,治疗组联合应用胺碘酮和氯沙坦治疗,随访12个月,观察2组心房颤动复发率和左房内径变化。结果治疗组心房颤动复发率明显低于对照组,左房内径小于对照组,差异均有统计学意义（P〈0.05）。结论氯沙坦联合胺碘酮可明显降低心房颤动复率后再复发,减小左房内径,效果优于单用胺碘酮。     

静脉应用胺碘酮治疗心房颤动复律的疗效观察

目的:观察静脉应用胺碘酮对心房颤动复律的临床疗效。方法:将172例心房颤动患者随机分为胺碘酮组和安慰剂组。胺碘酮组(n=87)静脉推注胺碘酮5mg·kg-1,再以胺碘酮10～20mg·kg-1·d-1加入0.9%氯化钠注射液中持续静脉滴注,维持直至恢复为窦性节律;安慰剂组(n=85)静脉推注和静脉滴注0.9%氯化钠注射液,并给予控制心室率治疗。观察2组复律成功率和复律时间。结果:胺碘酮组有74例(85.1%)恢复为窦性节律,安慰剂组有68例(80.0%)恢复为窦性节律,2组比较差异无统计学意义(P>0.05)。胺碘酮组心房颤动持续时间短于安慰剂组(P<0.01)。胺碘酮组1例患者出现窦性心动过缓,停药后恢复。结论:胺碘酮静脉应用不能提高复律率,但能缩短心房颤动持续时间。     

Pharmacological cardioversion of atrial fibrillation: current management and treatment options

Atrial fibrillation (AF) is the most common form of arrhythmia, carrying high social costs. It is usually first seen by general practitioners or in emergency departments. Despite the availability of consensus guidelines, considerable variations exist in treatment practice, especially outside specialised cardiological settings. Cardioversion to sinus rhythm aims to: (i) restore the atrial contribution to ventricular filling/output; (ii) regularise ventricular rate; and (iii) interrupt atrial remodelling. Cardioversion always requires careful assessment of potential proarrhythmic and thromboembolic risks, and this translates into the need to personalise treatment decisions. Among the many clinical variables that affect strategy selection, time from onset is crucial. In selected patients, pharmacological cardioversion of recent-onset AF can be a safely used, feasible and effective approach, even in internal medicine and emergency departments. In most cases of recent-onset AF, pharmacological cardioversion provides an important--and probably more cost effective--alternative to electrical cardioversion, which can then be employed as a second-line therapy for nonresponders. Class IC agents (flecainide or propafenone), which can be safely used in hospitalised patients with recent-onset AF without left ventricular dysfunction, can provide rapid conversion to sinus rhythm after either intravenous administration or oral loading. Although intravenous amiodarone requires longer conversion times, it is still the standard treatment for patients with heart failure. Ibutilide also provides good conversion rates and could be used for AF patients with left ventricular dysfunction (were it not for high costs). For long-lasting AF most pharmacological treatments have only limited efficacy and electrical cardioversion remains the gold standard in this setting. However, a widely used strategy involves pretreatment with amiodarone in the weeks before planned electrical cardioversion: this provides optimal prophylaxis and can sometimes even restore sinus rhythm. Dofetilide may also be capable of restoring sinus rhythm in up to 25-30% of patients and can be used in patients with heart failure. The potential risk of proarrhythmia increases the need for careful therapeutic decision making and management of pharmacological cardioversion. The results of recent trials (AFFIRM [Atrial Fibrillation Follow-up Investigation of Rhythm Management] and RACE [Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation]) on rate versus rhythm control strategies in the long term have led to a generalised shift in interest towards rate control. Although carefully designed studies are required to better define the role of pharmacological rhythm control in specific AF settings, this alternative option remains a recommendable strategy for many patients, especially those in acute care.     

Current management of symptomatic atrial fibrillation

Atrial fibrillation (AF) is the commonest arrhythmia. It presents in distinct patterns of paroxysmal, persistent and chronic AF, and patient management aims differ according to the pattern. In paroxysmal AF, drug treatment with beta-blockers, class Ic and class III agents reduce the frequency and duration of episodes. In persistent AF (recent onset, non-paroxysmal), early cardioversion with either pharmacological agents or by direct current (DC) cardioversion should be actively considered, in those patients who are suitable. Patients most likely to cardiovert and remain in sinus rhythm include those with duration of AF of <1 year, an acute reversible cause, left atrial diameter <50 mm and good left ventricular function on echocardiography. Recent data show that maintenance of sinus rhythm after successful cardioversion is enhanced by the use of class III drugs including amiodarone and dofetilide. In chronic or permanent AF, management is aimed at controlling the ventricular rate response with combinations of digoxin, beta-blockers and calcium antagonists with atrio-ventricular nodal activity (diltiazem and verapamil). There is some debate about the prognostic significance of AF. Certainly AF is associated with an excess mortality but this is largely accounted for by its association with serious intrinsic heart disease and the thrombo-embolic complications of the arrhythmia. Atrial fibrillation is a common default arrhythmia for the sick heart.     

急诊老年心房颤动快速心室率患者临床用药效果观察

摘要 目的：观察并比较静脉注射毛花甙C、地尔硫卓及胺碘酮控制老年房颤伴快速心室率的有效性和安全性。方法：收集于天津医科大学第二医院心脏科急诊诊治的心房颤动伴快速心室率的老年患者(≥60岁)97例,患者随机分为3组,分别静脉用毛花甙C(A组,30例)组、地尔硫卓(B组,32例)和胺碘酮(C组,35例)组。观察用药前及用药后5、l0、15、30、60、90min患者的心室率、血压、心律变化以及药物起效时间及不良反应。结果：毛花甙C、地尔硫卓和胺碘酮均能有效控制心房纤颤伴快速心室率患者的心室率。总有效率分别为75％、90％和85％,平均用药有效时间分别为(35.4±15.7)min、(9.7±3.6) min和(18.8±7.6)min。西地兰组恢复窦律6例,低血压l例;地尔硫卓组恢复窦律5例,出现低血压2例,窦缓l例;胺碘酮组恢复窦律8例,窦缓l例;均自行缓解,未发生心衰加重。结论：毛花甙C、地尔硫卓及胺碘酮均能有效、迅速、安全控制老年房颤伴快速心室率患者的心室率。但地尔硫卓、胺碘酮更迅速,而胺碘酮相对安全。