伊布利特与普罗帕酮转复心房颤动的疗效及电生理作用的差异  

Cardiac electrophysiologic effects of intravenous ibutilide compared with intravenous propafenone in patients with rencent-onset atrial fibrillation

作　　者：孙超[1] 刘书旺[1] 郭静萱[1] 

机构地区：[1]北京大学第三医院心内科,北京100191

出　　处：《中国心脏起搏与心电生理杂志》2011年第3期210-212,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的 观察静脉注射伊布利特和普罗帕酮转复心房颤动﹙简称房颤﹚的疗效以及两种药物对心房和心室电生理作用的差异。方法 采用随机、单盲对照研究，共入选房颤持续 1 4 d 的患者 37 例，随机进入伊布利特组﹙n =17﹚或普罗帕酮组﹙n =20﹚。两组分别静脉注射伊布利特 1 mg 或普罗帕酮 70 mg，给药时间 10 min，给药结束后 10 min 未转复窦性心律﹙简称窦律﹚者，重复上述治疗 1 次。观察给药开始后 4h 内房颤转复率，给药前后 QRS波时限及校正的 QT 间期﹙QTc﹚间期变化，以及不良反应发生情况。结果 ①伊布利特组 11 例﹙64. 7%﹚转复窦律，普罗帕酮组 9 例﹙45%﹚转复窦律，两组转复率无差异﹙P 〉0. 05﹚。②给药后 90 min 内，伊布利特组 QTc 间期较用药前显著延长﹙506. 4 ±53. 6 ms vs 446. 4 ±40. 1 ms，P 〈0. 001﹚；QRS 波时限有延长趋势﹙90. 6 ± 15. 1 ms vs88. 6 ±16. 8 ms﹚，但无统计学差异﹙P =0.07﹚。普罗帕酮组 QRS 波时限显著延长 ﹙96.9 ±20.4 ms vs 90.7 ±18.0 ms，P 〈 0. 01﹚；QTc 间期无显著差异﹙445. 2 ±41. 3 ms vs 440. 5 ±22. 1 ms，P 〉 0. 05﹚。③伊布利特组 4 例出现频发室性早搏、短阵室性心动过速。其中 1 例多形室性心动过速，发生在复律后窦性心动过缓伴 QTc 间期显著延长的病例。结论 静脉注射伊布利特转复房颤有效，可致心室复极时间显著延长，应注意给药后短期内室性心律失常发生情况；普罗帕酮对心室复极时间无影响，可延长心室除极时间。Objective The aim of this study is to compare cardiac electropbysiologie and antifibri]iatory effects of ibutilide with that of propafenone （introvenously） in converting recent-onset atrial fibrillation （AF）. Methods Thirty-seven patients with AF of less than 4 days＇ duration were randomized into two groups. Group A （ n = 17） received ibutilide ling, while Group B （n =20） were treated with propafenone 70 rag. if sinus rhythm was not present 10 minutes after the first infusion, a secoud infusion of the same dose was given. Continuous electrocardiographic monitoring was performed and 12-lead electrocar-diograms were recorded before dosing and at defined times from the start of infusion to 4 hours after dosing. Results In Group A, 11 patients （64.7%） converted into sinus rhythm compared with 9 patients （45%） in Group B （P 〉 0.05）. The mean peak QTc interval in Group A was significantly prolonged within 90 minutes after ibutilide administration（P 〈 0.001 ）, while it was of no change in Group B with propafenone treatment （P 〉0. 05）. However, a significant increase in the average peak QRS duration cou],d be seen after dosing in Group B （ P 〈0.01 ）. The most serious side effect was polymorphic ventricular tachycardia, which occurred in a patient immediately after the first infusion of ibutilide concluded. Sinus bradycardia and an excessively prolonged QTc were observed in the case. Conclusion Ibutilide and propafenone are equally effective in conversion of recent-onset AF to sinus rhythm. Ibutilide significantly prolongs ventricular repolarization, which may contribute to the onset of severe ventriocular tachycardia. Propafenone has no effects on QT interval ,however it prolongs ventricular depolarization.

关 键 词：心血管病学 伊布利特 普罗帕酮 心房颤动 室性心动过速 电生理作用 

分 类 号：R972.2[医药卫生—药品] R541.75[医药卫生—药学]