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目的观察胺碘酮联合缬沙坦治疗高血压并阵发性心房颤动患者的临床疗效。方法选取2012年3月—2014年3月沭阳协和医院收治的高血压并阵发性心房颤动患者90例,随机分为对照组和观察组,每组45例。两组患者入院后均给予胺碘酮治疗,对照组患者在此基础上给予依那普利,观察组患者在此基础上给予缬沙坦;两组患者均连续治疗1个月。比较两组患者治疗前及随访6个月、1年、2年的血压、左心房内径,随访6个月、1年、2年心房颤动复发率,治疗期间不良反应发生情况。结果治疗前后两组患者收缩压、舒张压比较,差异无统计学意义(P>0.05);不同时间点比较,差异有统计学意义(P<0.05);方法与时间在收缩压、舒张压上存在交互作用(P<0.05)。治疗前后两组患者左心房内径比较,差异有统计学意义(P<0.05);不同时间点比较,差异无统计学意义(P>0.05);方法与时间在左心房内径上无交互作用(P>0.05)。观察组患者随访6个月、1年、2年心房颤动复发率均低于对照组(P<0.05)。治疗期间对照组中有2例患者出现心动过缓,1例患者出现甲状腺功能异常;观察组患者治疗期间未出现明显不良反应。结论胺碘酮联合缬沙坦治疗有助于抑制高血压伴阵发性心房颤动患者左心房内径增大及减少心房颤动复发,有利于减少心房结构重构且安全性较高。
Objective To observe the clinical efficacy of amiodarone combined with valsartan in the treatment of patients with hypertension and paroxysmal atrial fibrillation. Methods From March 2012 to March 2014, 90 patients with hypertension and paroxysmal atrial fibrillation admitted to Shuyang Union Hospital were randomly divided into control group and observation group, with 45 cases in each group. Both groups were given amiodarone after admission. Patients in the control group were given enalapril on this basis. Patients in the observation group were given valsartan on this basis. Patients in both groups were treated continuously for 1 month. Blood pressure, left atrial diameter, 6-month follow-up, 1-year and 2-year rates of atrial fibrillation recurrence and adverse reactions during the treatment were compared between the two groups before treatment and at 6 months, 1 year and 2 years. Results There was no significant difference in systolic pressure and diastolic blood pressure between the two groups before and after treatment (P> 0.05). There were significant differences at different time points (P <0.05). The systolic and diastolic blood pressure There was an interaction (P <0.05). There was no significant difference in the left atrial diameter between the two groups before and after treatment (P <0.05). There was no significant difference at different time points (P> 0.05). There was no interaction between time and method in left atrial diameter > 0.05). The recurrence rate of atrial fibrillation in observation group was lower than that in control group at 6 months, 1 year and 2 years (P <0.05). During the treatment period, 2 patients in the control group had bradycardia and 1 patient had abnormal thyroid function. No significant adverse reactions occurred in the observation group during treatment. Conclusions Amiodarone combined with valsartan can inhibit the increase of left atrial diameter and reduce the recurrence of atrial fibrillation in hypertensive patients with paroxysmal atrial fibrillation, which is beneficial to reduce the remodeling of atrial structure and high safety.