摘要目的 观察非瓣膜病阵发性心房颤动(房颤)的患者应用替米沙坦在房颤复律后维持窦性心律的疗效. 方法 76例非瓣膜病变阵发性房颤患者,随机分为胺碘酮对照组和替米沙坦+胺碘酮治疗组(联合治疗组),观察治疗后3、6、12个月两组患者左心房内径的变化及评价窦性心律的维持效果. 结果 治疗3、6个月两组左心房内径和窦性心律维持率差异无统计学意义(分别为t=0.04、0.51和t=0.03、1.12,均为P>0.05).治疗1年后,两组窦性心律的维持率分别为48.4%和73.5%,左心房内径分别为(37.26±4.85)mm和(34.38±3.85)mm,联合治疗组窦性心律维持率高于对照组(t=4.33,P<0.05),左房内径小于对照组(t=2.66,P<0.05). 结论 替米沙坦联合胺碘酮对阵发性房颤复律后窦性心律维持优于单用胺碘酮治疗,随着时间延长,维持窦性心律效果越好,可能与替米沙坦抑制肾素血管紧张素系统,降低心脏负荷,抑制心房电及结构重构有关.

abstractsObjective To observe the curative effect of telmisartan on sinus rhythm maintenance in patients with nonvalvular paroxysmal atrial fibrillation (AF) after the recovery of sinus rhythm with amiodarone. Methods Seventy-six patients with nonvalvular paroxysmal atrial fibrillation who visited our hospital were randomly divided into two groups: control group (amiodarone, n=36) and treatment group (telmisartan plus amiodarone, n=40). The maintenance of sinus rhythm and the change of left atrial diameter between the two groups at 3, 6 and 12 months after therapy were observed. Results The left atrial diameter and the maintenance rate of sinus rhythm between the two groups at 3 and 6 months after therapy had no statistically significant difference (t=0.04, 0.51, 0.03, 1.12, all P>0.05). After 1-year treatment, the maintenance rates of sinus rhythm were 48.4% and 73.5% in treatment group and control group ,respectively (t=4.33,P<0.05), and the left atrial diameter was significantly shorter in treatment group than in control group [(34.38±3.85) mm vs. (37.26±4.85)mm ,t=2.66, P<0.05]. Conclusions The combination of telmisartan and amiodarone is more effective than amiodarone alone on maintenance of sinus rhythm in patients with nonvalvular paroxysmal AF after the recovery of AF. The curative effect may be due to telmisartan effects on inhibiting the activation of renin-angiotensin system, decreaseing the cardiac burden and delaying the cardiac remodeling.