培哚普利对老年房颤患者窦性心律维持作用的研究

目的探讨血管紧张素转换酶抑制剂（ACEI）培哚普利能否改善老年心房颤动（AF）患者转律后窦性节律维持的有效性及安全性。方法56例老年（≥65岁）AF患者,药物或电复律后,在继续口服胺碘酮基础上,分为培哚普利组和非培哚普利组,随访1年。分别于3、6、9、12个月统计窦律维持情况;于转律后24小时、3、6、12个月分别做同步12导联心电图检查,测取最大P波、最小P波,计算P波离散度（Pd）;于转律即刻、9、12个月做心脏超声检查,测定左房内径（LAD）、左室舒张末内径（LVEDD）、左室射血分数（LVEF）、舒张期二尖瓣口前向血流速度比值（E/A）。结果在随访第9和12个月,培哚普利组窦性心律的维持效果显著优于非培哚普利组;于随访的第6、12个月培哚普利组较非培哚普利组Pd显著缩小;心脏超声随访发现,9、12个月时培哚普利组左房内径显著缩小,左心室舒张功能显著改善（E/A比值）。结论培哚普利有助于老年AF患者转律后窦性心律维持,可显著减少左房内径,缩小P波离散度,并且有较高的有效性和安全性。

Study of perindopril on the maintenance of sinus rhythm after atrial fibrillation cardioversion in old patients

Objective： To explore clinical efficacy and safty of perindopril in maintaining the sinus rhythm after cardioversion of persistent atrial fibrillation.Methods： 56 cases of recency atrial fibrillation who had been successfully converted to sinus rhythm were randomly assigned into groupⅠ（32 cases,in which patients were treated with amiodarone plus perindopril） and groupⅡ（24 cases,in which patients were treated with amiodarone）.The therapeutic effects of all these cases on maintenance rates of sinus rhythm were followed up for 12 months.The left atrial diameter（LAD）,the left ventricular end-diastolic diameter（LVEDD）,LVEF and the velicity ratio of mitral valve（E/A） were measured in all patients by electrocardiography.P wave didpersion（Pd） was calculated.Results： The maintenance rate of sinus rhythm in the groupⅠwas significantly higher than that in groupⅡat the 9th month（P〈0.05）.The differences in LVEDD and LVEF were not significant between the two groups at the 12th month after treatment.Pd was significant at 6th month（P=0.004） and at 12th month（P=0.001）.At the 12th month after treatment,LAD in groupⅡwas significantly enlarged compared with that in groupⅠ（P〈0.05）.Conclusion： The combination of perindopril and amiodarone is effective and safe for sinus rhythm maintenance,and may delay the enlargement of LAD.