缬沙坦和贝那普利预防老年房颤转复后复发的作用及其机制

目的：探讨小剂量胺碘酮联合缬沙坦或贝那普利预防老年持续性房颤转复后房颤复发的作用及其机制。方法：150例持续性房颤患者（持续超过7d）,经药物或电复律后随机分为三组：胺碘酮组（Ⅰ组）,胺碘酮＋缬沙坦组（Ⅱ组）,胺碘酮＋贝那普利组（Ⅲ组）,各50例;治疗随访时间为1年,比较三组治疗后房颤的复发情况以及治疗前,治疗后第2周、3月、6月、12月的左心房内径。结果：142例完成治疗,随访12月,与I组比较,Ⅱ组和Ⅲ组心房颤动复发率（37.50%比17.39%比18.75%）明显降低,左房内径（38.11±1.24）mm比（34.11±1.37）mm比（34.13±1.36）mm]明显缩小（P均〈0.05）,而Ⅱ组和Ⅲ组间差异无显著性（P均〉0.05）。结论：胺碘酮分别与缬沙坦和贝那普利联合用于持续性房颤复律后预防房颤复发,较单用胺碘酮有效,长期服用可逆转左房扩大,抑制电重构,从而防止房颤复发。

Preventing effect of valsartan and benazepril on recurrence of atrial fibrillation in aged patients and their mechanism

Objective：To explore preventing efficacy of small dose of amiodarone combined valsartan or benazepril on recurrence of atrial fibrillation（AF）in aged patients with continuative AF after cardioversion and their mechanism.Methods：After drug or electrical conversion,a total of 150patients with continuative AF（lasted long than 7d）were randomly and equally divided into amiodarone group（group Ⅰ）,amiodarone＋ valsartan group（group Ⅱ）and amiodarone＋ benazepril group（group Ⅲ）;All patients were followed up for one year.AF recurrence,left atrial diameter（LAD）before,after treatment two weeks,three,six,and 12months were compared among three groups.Results：A total of 142cases completed the treatment.Compared with groupⅠafter 12-month follow up,there were significant decrease in recurrence rate of AF（37.50% vs.17.39% vs.18.75%）and LAD（38.11 ±1.24）mm vs.（34.11±1.37）mm vs.（34.13±1.36）mm]in group Ⅱ and group Ⅲ,P＆lt;0.05all,but there were no significant difference in above indexes between group Ⅱ and group Ⅲ,P＆gt;0.05.Conclusion：Compared with single usage of amiodarone,valsartan or benazepril combined amiodarone is more effective in maintenance of sinus rhythm in continuative atrial fibrillation after cardioversion,and long-term administration can reverse left atrial enlargement,inhibit electrical remodeling,and then prevent recurrence of atrial fibrillation.