内科

目的探讨胺碘酮联合西地兰治疗慢性心功能不全伴阵发性房颤患者的临床效果。方法选取2014年7月至2017年5月我院收治的慢性心功能不全伴阵发性房颤患者114例，采用随机数字表法分为观察组与对照组，每组57例。对照组患者给予胺碘酮治疗，观察组患者在对照组治疗的基础上联合西地兰治疗。3个月后，比较两组患者的临床疗效、左心房内径、左心房射血分数（LVEF）、血清C反应蛋白（CRP）、基质金属蛋白酶-2（MMP-2）水平、血脂指标水平及不良反应发生情况。结果观察组患者的治疗总有效率为94.74%，对照组为78.95%，观察组患者的临床疗效显著优于对照组，差异有统计学意义(P＜0.05）。治疗3个月后，两组患者的左心房内径显著减小、LVEF水平显著增高(P＜0.01)，观察组左心房内径小于对照组、LVEF水平高于对照组(P＜0.01)；两组患者的血清CRP、MMP-2水平均显著降低（P＜0.05或0.01），观察组患者的血清CRP、MMP-2水平显著低于对照组(P＜0.01)；两组患者TG、LDL-C水平均显著降低、观察组患者HDL-C水平显著升高(P＜0.01)；观察组患者TG、LDL-C水平低于对照组(P＜0.01)，HDL-C水平显著高于对照组(P＜0.01)。两组患者的不良反应发生率比较差异无统计学意义（P＞0.05）。结论胺碘酮联合西地兰治疗慢性心功能不全伴阵发性房颤患者临床疗效确切，能显著降低血清CRP、MMP-2水平，有效改善心房重构，同时可调节血脂，治疗安全性较高。

ObjectiveTo investigate the effect of amiodarone combined with cedilanid on the treatment of patients with chronic cardiac insufficiency and paroxysmal atrial fibrillation. Methods114 patients with chronic heart failure and paroxysmal atrial fibrillation admitted in our hospital from July 2014 to May 2017 were selected. The random digital table was used to divide into the observation group and the control group with 57 cases in each group. The control group were treated with amiodarone therapy, the observation group were treated with cedilanid based on the control group′s treatment. The clinical efficacy, left atrial diameter, left atrial ejection fraction (LVEF), serum C reactive protein (CRP), matrix metalloproteinase-2 (MMP-2) level, blood lipid index and adverse reactions were compared between the two groups after 3 months treatment. ResultsThe total effective rate of treatment was 94.74% in the observation group and 78.95% in the control group. The clinical efficacy of the observation group was significantly better than that of the control group, and the difference was statistically significant (P＜0.05). After 3 months of treatment, the left atrial diameter of the two groups decreased significantly, and the level of LVEF increased significantly (P＜0.01), the left atrial diameter of the observation group was smaller than that of the control group and the LVEF level was higher than that of the control group (P＜0.01). The levels of serum CRP and MMP-2 in the two groups were significantly decreased (P＜0.05 or 0.01). The serum CRP and MMP-2 levels of the patients in the observation group were significantly lower than those in the control group (P＜0.01). The levels of TG and LDL-C in the two groups were significantly decreased, and the level of HDL-C in the observation group was significantly higher (P＜0.01). The level of TG and LDL-C in the observation group was lower than that of the control group (P＜0.01), and the level of HDL-C was significantly higher than that of the control group (P＜0.01). There was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05). ConclusionThe clinical efficacy of amiodarone combined with cedilanid on the treatment of patients with chronic cardiac insufficiency and paroxysmal atrial fibrillation is determined. It can significantly reduce the level of serum CRP and MMP-2, effectively improve the remodeling of the atrium, adjust the blood lipid, The treatment process is safer.