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醫(yī)學(xué)免費(fèi)論文:胺碘酮聯(lián)合穩(wěn)心顆粒治療心房顫動(dòng)的療效研究
【摘要】 目的：探討胺碘酮聯(lián)合穩(wěn)心顆粒治療心房顫動(dòng)的療效和安全性。方法:將2007年1月至2008年1月間在我院住院治療的房顫(AF)患者隨機(jī)分為觀察組和對(duì)照組，兩組均給予胺碘酮治療，觀察組同時(shí)給予穩(wěn)心顆粒治療，評(píng)定兩組治療效果和副作用。結(jié)果:治療后兩組心室率均較治療前明顯降低，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后觀察組心室率明顯低于對(duì)照組，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組轉(zhuǎn)復(fù)所用時(shí)間明顯短于對(duì)照組，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組房顫轉(zhuǎn)復(fù)率為92.85%，對(duì)照組為88.09%，兩者比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。觀察組房顫總有效率為90.47%，對(duì)照組為76.19%，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組房顫復(fù)發(fā)率為2.63%，對(duì)照組為15.63%，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組患者均未影響治療，無(wú)肺纖維化、視力模糊、促心律失常作用等嚴(yán)重并發(fā)癥。結(jié)論:胺碘酮聯(lián)合穩(wěn)心顆粒治療心房顫動(dòng)能顯著提高臨床治療效果，無(wú)明顯毒副作用，值得推廣。
【關(guān)鍵詞】 胺碘酮; 穩(wěn)心顆粒; 心房顫動(dòng)
Observing the Effect of Amiodarone Combined withWenxin Particle on Atrial Fibrillation
LI Hua-de, NING Guan-lin, LI Dong-hua醫(yī).學(xué)全.在.線www.gydjdsj.org.cn
(The People's Hospital of Wuchuan, Guangdong Wuchuan 525400, Chnia)
Abstract： Objective: To investigate the effect and safety of amiodarone combined with wenxin particle on atrial fibrillation. Method: The cases with atrial fibrillation(AF) in our hospital from Jan. in 2007 to Jan. in 2008 were divided into observation group and control group.The two groups received the treatment of amiodarone, and the observation group received the treatment of amiodarone combined with wenxin particle. Result: The ventricular rate of two groups after treatment were lower than that before treatment, and there was significant difference between them(P<0.05).The ventricular rate of observation group was lower than that of control group after treatment, and there was significant difference between them(P<0.05).The recovery time of the observation group was fewer than that of control group, and there was significant difference between them(P<0.05).The recovery rate was 92.85% in the observation group and 88.09% in control group, and there was no significant difference between them(P>0.05). The total effective rate was 90.47% in the treatment group and 76.19% in control group, and there was significant difference between them(P<0.05). The relapse rate was 2.63% in the treatment group and 15.63% in control group, and there was significant difference between them(P<0.05). there were no serious complication about pulmonary fibrosis, blurred vision or arrhythmia. Conclusion: Amiodarone combined with wenxin particle in treating atrial fibrillation can improve the clinical effect and no obvious side effect, so it is worth being used widely.
Key words： Amiodarone; Wenxin particle; Atrial fibrillation
心房顫動(dòng)(AF，簡(jiǎn)稱(chēng)房顫) 是心內(nèi)科常見(jiàn)的心律失常之一，該病發(fā)病率高，常反復(fù)發(fā)作，不僅能造成心臟功能的衰竭，同時(shí)又能使缺血性腦卒中和全身栓塞事件的發(fā)生率顯著增加，具有極高的致殘率和死亡率，因此有效防治房顫具有重要的臨床意義。我們對(duì)2007年1月至2008年1月間在我院住院治療的房顫患者進(jìn)行胺碘酮聯(lián)合穩(wěn)心顆粒治療并取得滿意效果，現(xiàn)報(bào)告如下。
1 資料與方法
1.1 一般資料:選擇我院2007年1月至2008年1月住院的房顫患者84例，所有患者均經(jīng)病史詢問(wèn)、體格檢查、常規(guī)心電圖或24h動(dòng)態(tài)心電圖記錄確診，并常規(guī)查胸片、超聲心動(dòng)圖、肝腎功能及甲狀腺功能檢查，排除風(fēng)濕活動(dòng)、病竇綜合征、房室傳導(dǎo)阻滯、長(zhǎng)QT綜合征、甲狀腺及肝腎功能異常、洋地黃中毒、電解質(zhì)紊亂、碘過(guò)敏或?qū)Π返馔^(guò)敏者。將患者隨機(jī)分為觀察組和對(duì)照組，其中觀察組42例，男22例，女20例，年齡41～70歲，平均(59.50±4.26)歲;高血壓16例，冠心病14例，心臟瓣膜病6例，擴(kuò)張型心肌病3例，肥厚型心肌病2例，特發(fā)性房顫1例;陣發(fā)性房顫28例，持續(xù)性房顫14例。觀察組42例，男23例，女19例，年齡40～70歲，平均(59.52±4.24)歲;高血壓18例，冠心病13例，心臟瓣膜病5例，擴(kuò)張型心肌病4例，肥厚型心肌病1例，特發(fā)性房顫1例;陣發(fā)性房顫27例，持續(xù)性房顫15例。兩組患者在性別、年齡、病情等方面比較差異無(wú)統(tǒng)計(jì)學(xué)意義 (P>0.05)，具有可比性。
1.2 方法:兩組患者均針對(duì)原發(fā)病進(jìn)行系統(tǒng)治療，包括降血壓、擴(kuò)血管、改善心功能，同時(shí)給予胺碘酮(河南天方藥業(yè)股份有限公司生產(chǎn)，國(guó)藥準(zhǔn)字H410215922)負(fù)荷量0.2 g，3次/d，1周后0.2g，2次/d，從第3周開(kāi)始服用維持量0.2g，1次/d，半年后再減量，每3～6個(gè)月減1次，每次減量為每周0.4g。持續(xù)性房顫患者同時(shí)服用華法林2～2.5mg，1次/d。觀察組在此治療基礎(chǔ)上給予穩(wěn)心顆粒(山東步長(zhǎng)制藥有限公司，批準(zhǔn)文號(hào)：國(guó)藥準(zhǔn)字l10950026)治療，9g/次，3次/d。兩組均不用其他抗心律失常藥物。
1.3 療效評(píng)定標(biāo)準(zhǔn)[1]:顯效：陣發(fā)性房顫完全不發(fā)作或偶有發(fā)作，持續(xù)性房顫轉(zhuǎn)為竇性心律;有效：陣發(fā)性房顫發(fā)作減少60%以上(時(shí)間和次數(shù))，持續(xù)性房顫轉(zhuǎn)為陣發(fā)性房顫;無(wú)效：達(dá)不到以上標(biāo)準(zhǔn);復(fù)發(fā)：指顯效、有效患者在減量過(guò)程中房顫增加至≥2次/周。
1.4 統(tǒng)計(jì)學(xué)方法:采用t檢驗(yàn)、X2檢驗(yàn)等進(jìn)行統(tǒng)計(jì)分析。
2 結(jié) 果
2.1 兩組患者治療后1個(gè)月心室率及轉(zhuǎn)復(fù)所用時(shí)間比較:治療后兩組患者心室率均較治療前明顯降低，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);治療后觀察組患者心室率明顯低于對(duì)照組，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組轉(zhuǎn)復(fù)所用時(shí)間明顯短于對(duì)照組，兩者比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)，見(jiàn)表1。表1 兩組患者治療后1個(gè)月心室率及復(fù)率情況比較注：與治療前比較：^P<0.05; 與對(duì)照組比較：△P<0.05
