厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用。方法风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦+胺碘酮组(61例)。两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用。试验随访时间为18月。比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径。结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮+厄贝沙坦组,P<0.05。厄贝沙坦+胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异。结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发。

Combined Irbesartan and Amiodarone in Maintaining Sinus Rhythm in Patients with Rheumatic Heart Disease after Mitral Valve Replacement

Objective The purpose of the present study was to evaluate the effect of combined irbesartan and amiodarone to maintain sinus rhythm in patients with rheumatic heart disease after valve replacement. Methods One hundred and sixteen patients of rheumatic heart disease after valve replacement operation complicated with persistent atrial fibrillation were randomized to amiodarone monotherapy (n=55) or irbesartan plus amiodarone group(n=61). Electrical cardioversion was administered 2 weeks after of pharmaceutical treatment. Patients were followed up for 18 months. Left atrial diameter was measured at before and 6, 12, 18 months after treatment. Results After 12 months, the left atrial diameter in amiodarone monotherapy group was significantly greater than irbesartan plus amiodarone combined group (P<0.05). The maintenance rate of sinus rhythm in monotherapy group was significantly lower than that by combined group (P<0.05). Conclusion The results suggest that the combination of irbesartan with amiodarone are more effective than amiodarone in sinus rhythm maintenance for patients with long-lasting persistent atrial fibrillation. Irbesartan plus amiodarone inhibit the enlargement of left atrium and reduce recurrence rate of atrial fibrillation in rheumatic heart disease patients after valve replacement.