阵发性房颤药物治疗新进展

2021-06-06 武汉大学人民医院吴钢教授 MedSci原创

参松养心胶囊可以影响多个心肌细胞离子通道,明显抑制阵发性房颤的发生和持续,改善心慌、头晕、气短等症状。 参松养心胶囊是我国第一个开展循证医学临床研究治疗心律失常的中成药。

      心房颤动又称为房颤,属于快速性心律失常,是指心房内产生不规则的冲动,心房内各部分肌纤维极不协调的乱颤,从而丧失了有效的收缩。房颤是一种常见的、危险的心律失常,会使患者的死亡风险增加2倍、发生脑卒中的风险增加5倍,其中阵发性房颤占很大一部分。

      房颤的发生率很高,据统计,发病率在1%左右,而且随着年龄的增大,房颤的发病率呈增高的趋势。80岁以上老年人,房颤的发病率可以达到10%。我国已经步入老龄化社会,老年人群的增加使房颤的发病率越来越高,房颤患者的总体人群数量庞大。据估测,我国的房颤人群在1000万以上。如何有效防治房颤,是目前血管领域的重要任务。

      阵发性房颤突如其来,病人压力很大

     阵发性房颤是指房颤持续时间≤7天(常≤2天),一般能自行终止,可反复发作。阵发性房颤是房颤中比较轻的类型,但是其危害并不比持续性房颤小。其主要危害包括:频繁发作,症状严重,降低生活质量;形成血栓、导致中风、患者致残;导致心房扩大、患者心功能下降等。

     阵发性房颤往往发作比较突然,当阵发性房颤发生时,患者会感到心慌,有时胸部会有疼痛、压迫等不适感。有些患者因阵发性房颤而失眠,睡觉时感觉心脏乱跳,睡眠不安。还有的患者在运动或轻度体力活动后出现气短、疲乏无力、头晕眼花的症状,甚至有的患者还会出现昏倒的现象。这也给患者带来了很大的心理压力。

      阵发性房颤是临床上易漏诊的房颤类型,被称为“隐形杀手”。若不及时治疗,危害极大,容易形成脑梗。因为当心房颤动时,心房丧失了收缩功能,心房的附属结构左心耳则基本处于不收缩或蠕动状态,心房中的血液无法完全被泵出,而瘀滞在左心耳内内,时间长了瘀滞的血液会逐渐凝结成块,形成血栓,血栓可随血液运行到身体各处,进入脑部血管后,很容易堵塞在脑血管狭窄处,阻断脑供血,导致脑梗发生。这是房颤最常见的危害之一,已经引起了医学界和患者的高度重视。

      由于房颤反复发作,左心房会逐渐增大,严重时累计右心室扩大,扩大的心脏,其功能下降,导致慢性心力衰竭,患者会出现胸闷、气促、夜间不能平卧,下肢浮肿的症状。一旦形成这种结局,药物治疗效果欠佳。

      此外,据临床观察,房颤患者,尤其是老年房颤患者,很容易出现记忆力下降、严重出现痴呆。房颤发作导致患者出现上述合并症,患者往往反复住院治疗,耗费家庭大量精力和财力,国家卫生支出也因此大量增加。

      阵发性房颤的治疗现状

      阵发性房颤的治疗包括药物治疗,包括西药和中药、导管射频消融术等。

      目前治疗阵发性房颤的抗心律失常药物有胺碘酮、心律平,此外倍他洛克和比索洛尔也广泛应用。胺碘酮和心律平对房颤的治疗有较好的效果。当阵发性房颤发作时,使用胺碘酮或者心律平静脉注射,大多数都可以转复,转复后使用片剂口服,60-70%的患者可以维持正常心律,数年内不发作。但是这两个药物尤其严重的缺点,就是副作用大,不适合长期服用。胺碘酮在短期内就容易导致甲状腺病变,包括甲状腺功能亢进和减退,还可能导致严重的肝损害、非纤维化、眼底病变等。心律平则可能导致室性心律失常。所以这些药物都不适合长期应用,一般在严密监护下使用2-3个月就要考虑停药。而停药后,房颤仍然会复发。倍他乐克和比索洛尔是B受体阻滞剂,副作用主要是导致心动过缓和血压降低,比上述两个药物安全,但是效果不佳,基本不能转复房颤,对于维持正常心律的效率也比较低。也不适合做为预防阵发性房颤发作的主导药物。

      射频消融术治疗心律失常始于20世纪80年代中期,这是一种介入性技术,将射频电流通过一根特制的电极导管输出到心脏某一特定的区域,通过破坏局部心肌异位起搏点达到治疗目的,具有不开胸、疗程短、痛苦小等优点。

      心脏射频消融术主要应用于治疗快速性心律失常,对于房颤的治疗具有一定的作用,但是,尽管如此,心脏射频消融术依然有可能引起一些并发症,如气胸、血胸、出血、感染等,甚至还会出现刺破心脏的情况。实施射频消融术难度高,风险大,需要慎重选择。对于年龄大、左心房增大显著、合并症较多的患者也不合适。

       中药治疗阵发性房颤效果显著

      中成药近年在心律失常治疗领域异军突起。祖国医药在既往就有治疗心律失常的探索,形成了一些理论和有效的验方。根据通络理论研制的参松养心胶囊在阵发性房颤的治疗中得到了有效验证。通络中药在治疗阵发性房颤方面具有整合调节的独特优势。房颤发生的直接原因是心肌细胞代谢紊乱,而心脏离子通道运行正常,心肌细胞代谢才能正常,因此,调整心肌细胞所有离子通道,使之正常运行,是有效治疗房颤的关键。心肌离子通道有很多种,如钙离子通道、钠离子通道等等,一般西药只能影响其中一种或几种离子通道,无法同时调整所有离子通道。中药参松养心胶囊可以同时对所有离子通道进行整合调节,中国医学科学院阜外心血管病医院浦介麟教授研究发现,参松养心胶囊对心肌细胞钠、钾、钙等多种离子通道均有调节作用。首都医科大学北京朝阳医院心脏中心的专家对参松养心胶囊研究后也发现,参松养心胶囊可以影响多个心肌细胞离子通道,明显抑制阵发性房颤的发生和持续,改善心慌、头晕、气短等症状。

 

     参松养心胶囊是我国第一个开展循证医学临床研究治疗心律失常的中成药。也就是说,运用西医的评价体系对参松养心胶囊进行了严格的临床试验,结果发现,房颤患者服用参松养心胶囊,有效治疗房颤、控制症状的基础上,还能有效预防房颤患者脑中风的发生,对房颤患者的心功能有显著的改善作用,降低了致残率,提高了患者的生活质量。近期的关于房颤治疗的指南已经把参松养心胶囊推荐为阵发性房颤治疗的重要药物。

 

 

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    2021-07-23 ms1000000667708938

    学习了

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    2021-07-10 413424595

    文章内容和标题不太匹配

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    2021-06-06 1851ef460am

    这算进展?

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1002030, encodeId=2160100203009, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=86ed5554529, createdName=ms1000000667708938, createdTime=Fri Jul 23 15:39:25 CST 2021, time=2021-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=998267, encodeId=fc2099826e62, content=文章内容和标题不太匹配, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e301523945, createdName=413424595, createdTime=Sat Jul 10 20:17:37 CST 2021, time=2021-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423542, encodeId=68b31423542b8, content=<a href='/topic/show?id=a1a69e630b5' target=_blank style='color:#2F92EE;'>#阵发性房颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97630, encryptionId=a1a69e630b5, topicName=阵发性房颤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36783798280, createdName=lqrandywkz, createdTime=Tue Jun 08 02:46:57 CST 2021, time=2021-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=971407, encodeId=75609e140745, content=这算进展?, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43572067033, createdName=1851ef460am, createdTime=Sun Jun 06 22:57:01 CST 2021, time=2021-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=971348, encodeId=a2c69e134871, content=<a href='/topic/show?id=3d2510429025' target=_blank style='color:#2F92EE;'># 参松养心胶囊#</a>的软文哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104290, encryptionId=3d2510429025, topicName= 参松养心胶囊)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=小小医者, createdTime=Sun Jun 06 18:22:01 CST 2021, time=2021-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031402, encodeId=788f1031402d2, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Sun Jun 06 14:46:57 CST 2021, time=2021-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=971280, encodeId=d1d79e1280c6, content=房颤是一种常见的、危险的心律失常, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=言西早, createdTime=Sun Jun 06 12:30:10 CST 2021, time=2021-06-06, status=1, ipAttribution=)]
    2021-06-06 小小医者
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    2021-06-06 心介

    房颤,临床上碰到很多哦

    0

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    2021-06-06 言西早

    房颤是一种常见的、危险的心律失常

    0