【摘要】 目的:观察血管紧张素转换酶抑制剂(ACEI)能否改善胺碘酮维持心房颤动患者的窦性心律的效果,并探讨其机制。方法:54例持续性心房颤动患者经口服胺碘酮转律成功后,在继续口服胺碘酮的基础上,依是否服用ACEI分为ACEI组(23例)和非ACEI组(31例),随访12个月,分别于3个月、6个月、9个月和12个月统计窦性心律的维持情况,于转律后24小时、6个月和12个月分别做12导联同步心电图计算P波离散度,于转律后即刻、转律后12个月分别做超声心动图检查测定左心房直径、左心室舒张末期直径、左心室射血分数、二尖瓣前叶活动曲线E峰和A峰的比值(E／A值)等。结果:在随访的第9个月和第12个月,ACEI组维持窦性心律的效果显著优于非ACEI组(60．87％和29．03％,P< 0．05;52．17％和22．58％,P<0．05)。于随访的第12个月,ACEI组的P波离散度较非ACEI组显著缩小[(37．50±7．54)ms和(48．57±3．78)ms,P=0．001]。心脏超声随访发现,12个月时ACEI组的左心房直径较非ACEI组显著缩小[(3．23±0．15)cm和(3．50±0．28)cm,P=0．009]、左心室舒张功能(E／A比值)显著改善(P=0．039)。结论:ACEI有助于改善胺碘酮维持心房颤动患者窦性心律的效果,改善心房的电生理特性和左心房结构的重构。更多还原

【Abstract】 Objective:To investigate whether angiotensin converting enzyme inhibitor (ACEI) can improve the effect of amiodarone on maintaining sinus rhythm of patients with persistent atrial fibrillation and to clucidete its mechanism. Methods:Fifty-four patients with reconstructed sinus rhythm on oral amiodarone were divided into two groups; ACEI group (n = 23) and non-ACEI group (n =31 ). The patients on amiodarone were followed up for 12 months. The rates of sinus rhythm were calculated at different time points (3 , 6, 9 and 12 months). Dispersion of P wave (Pd) was measured at 24 hours,6 and 12 months after sinus rhythm was rebuilt. Ultrasonic cardiography was also performed to explore changes of left atrial diameter (LAD) , left ventricle end-diastolic diameter (LVEDD) , left ventricle ejection fraction (LVEF) and E/A ratio immediately and at 24 hours and 12 months after sinus rhythm being rebuilt. Results:The rate of sinus rhythm in ACEI group was significantly higher than that in non-ACEI group at 9 and 12 months, respectively (60.87% vs 29. 03% ,P<0. 05;52. 17% vs 22.58% ,P<0. 05). Pd was significantly shortened in ACEI group at 12 months (37. 50±7. 54 ms vs 48. 57±3. 78 ms,P =0. 001). In ACEI group, LAD was decreased (3. 23±0. 15 cm vs 3. 50±0. 28 cm,P = 0. 009) and the diaslolic function of left ventricle (E/A ratio) was significantly improved(P=0. 039)at 12 months. Conclusions : ACEI does improve the effect of amiodarone on maintaining sinus rhythm of patients with persistent atrial fibrillation. It can also improve electrophysiological and morphological remodeling of left atrium.更多还原