硫氮卓酮配合胺碘酮与单用胺碘酮对急性阵发性心房纤颤复律效果的比较  

The efficacy of diltiazem combined with amiodarone versus that of amiodarone alone for rapid atrial fibrillation

作　　者：杨建坤[1] 赵丽[1] 韩凌[2] 王平[1] 王泊雅 刘士力 李京[1] 张颖[1] 尹月秋[1] YANG Jiankun;ZHAO Li;HAN Ling;WANG Ping;WANG Bo-ya;LIU Shi-li;LI Jing;ZHANG Ying;YIN Yue-qiu(Department of Emergency Medicine,Fuxing Hospital Affiliated to Capital University of Medical Sci.ences,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院急诊科,北京100038 [2]首都医科大学附属复兴医院心内科,北京100038

出　　处：《实用医学杂志》2018年第18期3106-3109,共4页The Journal of Practical Medicine

基　　金：北京市西城区青年科技人才培养(科技新星)项目(编号:XWKX2016-07);北京市科协金桥工程种子基金(编号:JQ201708)

摘　　要：目的探讨硫氮卓酮配合胺碘酮对急性房颤复律效果是否优于单用胺碘酮法。方法将138例符合标准发作<48 h的急性快速心室率心房纤颤患者随机分为观察组(42例),给予硫氮卓酮10~20μg/(kg·min)持续泵注,同时给予胺碘酮150 mg静脉推注,继续1 mg/min静脉泵注,1 h后心室率仍大于100次/min则再次给予胺碘酮75 mg静脉推注,维持1 mg/min静脉泵注,在心室率低于60次/min时暂停硫氮卓酮。对照组(96例),不用硫氮卓酮,余同观察组。收集并记录就诊时心室率、血压、发作至就诊时间;心率降至90次/min时间;在48 h时间窗内成功复律例数,用药至复律时间;记录有无胸闷、胸痛、头痛、头晕等不良事件,复律后血压,心率。应用SPSS 18.0软件进行统计分析,以P <0.05为有显著性差异。结果观察组95.24%(40/42例)患者成功转复,对照组95.83%(92/96例)患者成功转复,两组相比差异无统计学意义(P> 0.25)。两组复律时间:观察组为(7.41±1.03)h,对照组为(7.57±0.74)h,两组相比差异无统计学意义(P=0.903)。两组间心率降至90次/min时间:观察组为(113±19)min,对照组为(183±16)min,两组相比有统计学差异(P=0.006)。复律时舒张压观察组(63.90±1.77)mmHg低于对照组(71.63±1.73)mmHg(P=0.003)。结论硫氮卓酮配合胺碘酮治疗阵发性急性快速心室率心房纤颤临床可行,可尽快缓解患者心悸、胸闷等症状;但复律所需时间及成功率与单用胺碘酮无差别;硫氮卓酮配合胺碘酮或单用胺碘酮均具有较高急性房颤复律成功率。Objective To explore the efficacy of diltiazem combined with amiodarone and that of amioda-rone alone for rapid atrial fibrillation.Methods 138 patients who had atriaI fibriIIation with a rapid ventricular rate on acute attack within 48 h were randomly divided into 2 groups.The study group(n=42)received intrave-nous infusion of diltiazem 10~20μg/(kg·min),and additional amiodarone injection of 150mg and continuous in-travenous infusion at 1 mg/min.One hour after treatment,the patients with a heart rate of greater than 100 beats/min received another 75 mg amiodarone injection and then intravenous infusion at 1 mg/min.Use of diltiazem stopped temporarily as heart rate was lower than 60 beats/min.The control group(n=96)received the same thera-peutic schedule as the study group except lack of diltiazem.The initial heart rate,blood pressure,interval from at-tack to doctor visit,time to a heart rate of 90 beats/min,number of cases with cardioversion to sinus rhythm,and time to conversion after use of medication were recorded.Blood pressure and heart rate after conversion and adverse reactions including chest distress,chest pain,headache,and dizzy were recorded.P<0.05 was considered to have statistical difference.Results There were 95.24%patients(40/42)succeeded in cardioversion to sinus rhythm in the study group,while 95.83%patients(92/96)in the control group,with no significant difference(P>0.25).Conversion time did not differ significantly between the two groups[(7.41±1.03)h in the study group and(7.57±0.74)h in the control group](P=0.903).Time to reduction in heart rate to 90 beats/min differed sig-nificantly between the two groups[(113±19)min in the study group and(183±16)min in the control group](P=0.006).Diastolic pressure was lower in the study group than in the control group[(63.90±1.77)mmHg vs.(71.63±1.73)](P=0.003).Conclusions It is clinically feasible for diltiazem combined with amiodarone to treat acute attack rapid atrial fibrillation.It can rapidly relieve chest distress and palpitation.The time fo

关 键 词：硫氮卓酮 胺碘酮 急性房颤 复律 

分 类 号：R541.75[医药卫生—心血管疾病]