依那普利治疗高血压并阵发性房颤的超声改变和疗效

目的：探讨依那普利对原发性高血压并阵发性房颤患者的干预作用并观察P波最大时限（Pmax）、P波离散度（Pd）、左心房内径（LAD）的变化。方法：治疗组给予依那普利5mg/d,服用1周,无效者在第2周开始将依那普利加大剂量至10～15mg/d,患者出院后,每1周门诊随访1次,共6个月;对照组给予吲达帕胺2.5mg/d,随访同上。用药期间及用药后观察患者的临床症状及体征变化,记录房颤的发作次数和持续时间,并观察生化指标的改变,服药6个月后复查12导联同步ECG及心脏彩超。结果：（1）治疗后两组有显著的降压效果,但无显著差异（P〉0.05）;（2）治疗6个月后,①窦性心律时,吲达帕胺组治疗前后Pmax,Pd无显著性差异（P〉0.05）;依那普利组则Pmax,Pd均显著降低（P〈0.05）;②LAD：吲达帕胺组较治疗前明显扩大（P〈0.05）,而依那普利组则无明显改变（P〉0.05）;（3）在随访的6个月中,依那普利组平均每例房颤发作次数显著少于吲达帕胺组（6.1±2.5）次∶（7.6±2.8）次,P〈0.05;平均每次房颤发作的时间（min）明显短于吲达帕胺组（146.8±39.4）min∶（197.2±43.7）min,P〈0.05。结论：依那普利治疗房颤优于吲达帕胺,其可能机制为降低交感神经张力,改善心房重构。

Effect of Enalapril on paroxysmal atrial fibrillation in patients with essential hypertension

Objective： To study the effects of Enalapril on paroxysmal atrial fibrillation （PAF） in essential hypertension （EH） patients. Methods, The 86 EH patient with PAF were randomly divided into two groups [treatment group and control group （treated with indapamide）]. P-wave maximal duration （Pmax）, P-wave dispersion （Pd） were measured by 12-lead electrocardiography （ECG） and the left atrial diameter （LAD） were measured by colour Doppler echocardiography in all patients. Results： There was significantly reduced blood pressure in two groups （P〈0. 05）, but no significant difference （P〉0. 05） between two groups. P Pd and LAD were significantly decreased in Enalapril （10mg/d） treatment group as compared with control group after 6 months treatment （P〈0. 05）. The incidence of PAF in Enalapril group was less than that of control group [ （6. 1± 2. 5） times ： （7. 6±2.8） times, P〈0. 05]. Conclusion： Effect of Enalapril on PAF is more than that of indapamide, may be due to decrease sympathetic tone and improve atrial remodeling.