摘要目的:观察醛固酮受体拮抗剂螺内酯对起搏器术后患者房颤的预防效果及对左房内径和心功能影响。方法:选取2018年1月至2019年4月双腔起搏器植入的患者共84例,入组前均排除房颤,用随机数字表法随机分为螺内酯组(42例)和对照组(42例),螺内酯组在常规治疗基础上加用螺内酯(20mg/d)口服,对照组予起搏器术后常规治疗,两组均于术前和术后1、3、6、12个月行超声心动图检查(记录左房内径和左室射血分数)、测定血醛固酮水平,术后1、3、6、12个月程控起搏器并记录房颤复发情况。结果:经过12个月的随访,螺内酯组房颤发作7例(16.7%),对照组房颤发作15例(35.8%),差异无统计学意义(P=0.081),术后12个月螺内酯组的左房内径(LA)较对照组小(31.3±2.3mm vs 33.8±2.1mm),差异有统计学意义(P<0.05)。两组间各时间段的左室射血分数(EF)无显著差异(P>0.05)。螺内酯组的血醛固酮水平在术后的第3个月和第6个月较对照组低,差异有显著性(P<0.05),但6个月后水平逐渐上升,第12个月时两组间差异无显著性(P>0.05)。结论:起搏器术后应用醛固酮受体拮抗剂可延缓左房扩张,其机制可能是通过抑制醛固酮的作用,长期应用有可能减少和延缓起搏器术后房颤的发作。
Abstract：Objective: To evaluate the preventive effects of spironolactone (SPI, one of the aldosterone receptor antagonists) on atrial fibrillation of patients after pacemaker implantation and impacts on left atrial diameter and cardiac function. Methods: From January 2018 to April 2019, a total of 84 patients with dual chamber pacemaker implantation were selected. Atrial fibrillation was excluded before entering the group. The patients were randomly divided into two groups: the spironolactone group (42 cases) and the control group (42 cases). The spironolactone group was treated with oral spironolactone (20mg / D) on the basis of routine treatment, and the control group was treated with routine treatment after pacemaker operation. The patients in the two groups were superceded at 1, 3, 6 and 12 months before and after operation Echocardiography (recording left atrial diameter and left ventricular ejection fraction) and serum aldosterone level were measured. Pacemakers were programmed 1, 3, 6 and 12 months after operation and the recurrence of AF was recorded. Results: After 12-month follow-up visit, there are 7 cases (16.7%) of recurrence of atrial fibrillation in spironolactone group and 15 cases (35.8%) in control group. Therefore, there are no significant difference (p=0.081). Within 12 months after operation, left atrial diameter in spironolactone group is smaller than that of control group (31.3±2.3mm vs. 33.8±2.1mm). Obviously, the difference has statistical significance (P<0.05). However, during each period, there is no significant difference with regard to left ventricular ejection fraction among two groups (P>0.05). The level of plasma aldosterone of spironolactone group is smaller than that of control group in the 3rd and 6th month after operation with significant difference (P<0.05), but the level is increasing after 6 months until there is no significant difference in 12th month (P>0.05). Conclusion: Left atrial expansion can be delayed by taking spironolactone. The mechanism is to suppress the function of aldosterone. Long-term application may reduce and delay recurrence of atrial fibrillation after pacemaker implantation.
吴有华, 李楠, 徐宝华. 醛固酮受体拮抗剂防治起搏器术后房颤的临床研究[J]. 河北医学, 2020, 26(4): 649-653.
WU Youhua, LI Nan, XU Baohua. Clinical Study of Aldosterone Receptor Antagonists in the Prevention and Treatment of Atrial Fibrillation after Pacemaker Operation. HeBei Med, 2020, 26(4): 649-653.
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2020, Vol. 26 
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