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目的探讨慢性心力衰竭患者缬沙坦治疗后,血浆镁浓度(PMC)、红细胞镁含量(EMC)和红细胞Na+/Mg2+交换速率与心律失常的相关性。方法收集2006年3月至2007年3月哈尔滨医科大学第一临床医学院心内科128例充血性心力衰竭病例并随机分为两组,常规治疗加缬沙坦组(观察组)和不加缬沙坦组(对照组),采用原子吸收光谱火焰法测定两组治疗前、治疗6个月后PMC、EMC以及Na+/Mg2+交换速率,以Holter检测两组治疗6个月时心律失常发生情况。结果(1)治疗前两组PMC、EMC、VTmax(红细胞总镁外流量最大速度)、VNImax(红细胞非钠依赖性镁外流最大速度)、VNDmax(红细胞钠依赖性镁外流最大速度)比较差异无统计学意义(P>0.05)。(2)治疗6个月后,观察组PMC、EMC与对照组比较差异均有统计学意义(P<0.05,P<0.01);观察组VNImax与对照组比较差异无统计学意义(P>0.05);观察组VTmax、VNDmax与对照组比较均明显降低,差异均有统计学意义(P<0.01)。(3)两组治疗6个月后,观察组各种心律失常的发生较对照组显著减少。结论(1)心衰治疗加缬沙坦后,Na+/Mg2+交换速率降低,PMC与EMC增加,并由此减少了各种心律失常的发生。(2)缬沙坦的抗心律失常作用可能与增加了细胞的Mg2+稳态有关。
Objective To investigate the relationship between plasma magnesium concentration (PMC), erythrocyte magnesium content (EMC) and erythrocyte Na + / Mg2 + exchange rate and arrhythmia in patients with chronic heart failure after valsartan treatment. Methods From March 2006 to March 2007, 128 cases of congestive heart failure in Department of Cardiology, the First Clinical Medical College of Harbin Medical University were collected and randomly divided into two groups. The patients in the conventional treatment plus valsartan group (observation group) Sham group (control group). The exchange rate of PMC, EMC and Na + / Mg2 + were measured before and 6 months after treatment by flame atomic absorption spectrometry. Holter was used to detect the occurrence of arrhythmia in both groups for 6 months. Results (1) The difference of PMC, EMC, VTmax (maximum rate of erythrocyte total magnesium outflow), VNImax (maximum rate of erythrocyte non-sodium-dependent magnesium outflow) and VNDmax (erythrocyte sodium-dependent magnesium outflow) Statistical significance (P> 0.05). (2) After 6 months of treatment, there were significant differences in the PMC and EMC between the observation group and the control group (P <0.05, P <0.01). There was no significant difference in the VNImax between the observation group and the control group ). The VTmax and VNDmax in the observation group were significantly lower than those in the control group, with statistical significance (P <0.01). (3) After 6 months of treatment, the occurrence of arrhythmia in the observation group was significantly reduced compared with the control group. Conclusions (1) After the treatment of heart failure plus valsartan, Na + / Mg2 + exchange rate decreased, PMC and EMC increased, and thus reduce the incidence of various arrhythmias. (2) The antiarrhythmic effect of valsartan may be related to increasing the cell’s Mg2 + homeostasis.