本文關(guān)鍵詞：培哚普利干預(yù)房顫射頻消融術(shù)后復(fù)發(fā)的短期及長(zhǎng)期隨訪研究　出處：《浙江大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 房顫 復(fù)發(fā) 腎素-血管緊張素 重構(gòu)

【摘要】：目的與背景:心房顫動(dòng)與腦卒中及全身栓塞事件密切相關(guān),房顫射頻消融術(shù)是房顫患者目前最重要的復(fù)律治療措施之一。但消融術(shù)后房顫的復(fù)發(fā)仍然很常見,在某種程度上會(huì)影響導(dǎo)管消融成為房顫的一線治療的地位。在這些容易復(fù)發(fā)的房顫患者中,房顫的防治仍是一個(gè)很大的困難,也顯得很重要。培哚普利可通過抑制腎素-血管緊張素系統(tǒng),改善心房的解剖重構(gòu)和電重構(gòu),從而減少房顫的發(fā)作和持續(xù)的時(shí)間,這在房顫接受電復(fù)律或者藥物復(fù)律治療的患者中,已經(jīng)得到證實(shí)。在房顫接受射頻消融治療患者中,是否有同樣的效果,并沒有相關(guān)臨床隨機(jī)對(duì)照研究證實(shí)。我們當(dāng)前的研究旨在證明培哚普利(8mg)在房顫患者實(shí)施肺靜脈隔離術(shù)后可以幫助控制房顫的早期和遠(yuǎn)期復(fù)發(fā)。方法:本研究納入256位陣發(fā)性房顫患者,接受環(huán)肺靜脈隔離的射頻消融治療,被隨機(jī)分配至服用三個(gè)月的培哚普利組(8mg,每日一次)及安慰劑組。收集患者一般資料,包括年齡、性別、體重指數(shù)、收縮壓和舒張壓,高血壓病史,糖尿病史,吸煙史,藥物使用等。研究的主要終點(diǎn)是房顫消融后三個(gè)月以及一年的房顫復(fù)發(fā)率。所有患者分別檢查術(shù)前、術(shù)后以及隨訪三個(gè)月和一年后血管緊張素-II(angiotensin Ⅱ Ang-Ⅱ)水平,動(dòng)態(tài)心電圖和經(jīng)胸廓的超聲心動(dòng)圖。超聲心動(dòng)圖評(píng)估左室舒張末期內(nèi)徑,左心室的射血分?jǐn)?shù)和左心房前后徑。結(jié)果:經(jīng)過三個(gè)月的隨訪,在126例對(duì)照組病人中,房顫復(fù)發(fā)者有33例(26.19%),在130例服用8mg培哚普利的治療組中,房顫復(fù)發(fā)者有19例(14.62%),兩組之間差異有顯著性(P=0.021)。隨訪至一年,在126例對(duì)照組病人中,房顫復(fù)發(fā)者有36例(28.5%),在130例服用8mg培哚普利的治療組中,房顫復(fù)發(fā)者有21例(16.2%),兩組之間差異有顯著性(P = 0.017)。經(jīng)過一致性檢驗(yàn),隨訪至三個(gè)月和一年后比較,在對(duì)照組K值為0.94(P0.001),培哚普利組K值為0.96(P0.001),即不管在哪個(gè)組,3月和1年的復(fù)發(fā)率具有一致性。隨訪三個(gè)月和一年,血清Ang-Ⅱ水平是一個(gè)重要的預(yù)測(cè)房顫復(fù)發(fā)的獨(dú)立因素,在兩組之間差異有顯著性(p0.001)。Ang-Ⅱ水平可能與左房體積減少相關(guān)(r = 0.17,P =.005 at3months;r = 0.25,P.001at1year),左心房重構(gòu)改善,從而降低房顫射頻消融術(shù)后的房顫復(fù)發(fā)。結(jié)論:培哚普利是抑制房顫經(jīng)環(huán)肺靜脈隔離術(shù)后早期和遠(yuǎn)期復(fù)發(fā)的有效且安全的治療方法,這可能與血清Ang-Ⅱ顯著下降有關(guān),從而改善左心房重構(gòu),減少射頻消融術(shù)后房顫復(fù)發(fā)。本研究為注冊(cè)研究:XXXXXXXXXXX
[Abstract]:Objective and background: atrial fibrillation is closely related to stroke and systemic embolism events. Radiofrequency ablation of atrial fibrillation is one of the most important measures of cardioversion in patients with atrial fibrillation, but the recurrence of atrial fibrillation after ablation is still very common. To some extent, catheter ablation may affect the position of catheter ablation as a first-line treatment for atrial fibrillation. In these patients with recurrent atrial fibrillation, the prevention and treatment of atrial fibrillation is still a major difficulty. Perindopril can reduce the onset and duration of atrial fibrillation by inhibiting the renin-angiotensin system and improving the anatomic and electrical remodeling of the atrium. This has been confirmed in patients with atrial fibrillation undergoing electrocardioversion or drug cardioversion. In patients with atrial fibrillation treated with radiofrequency ablation, the same effect has been observed. There is no clinical randomized controlled study. Our current study aims to prove that perindopril is 8 mg). Pulmonary vein isolation in patients with atrial fibrillation can help to control the early and long-term recurrence of atrial fibrillation. Methods: 256 patients with paroxysmal atrial fibrillation were included in this study. Radiofrequency catheter ablation (RFCA) with circumferential pulmonary vein isolation was randomly assigned to the 3-month perindopril group (once a day) and the placebo group. General data of the patients, including age and sex, were collected. Body mass index, systolic and diastolic blood pressure, hypertension history, diabetes history, smoking history. Drug use etc. The main end point of the study was the recurrence rate of AF three months and one year after AF ablation. All patients were examined preoperatively. Angiotensin 鈪，

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