围术期应用胺碘酮预防治疗心脏术后心房颤动

Preoperative amiodarone against atrial fibrillation after cardiac surgery.

目的评价心脏手术围术期预防性应用胺碘酮对术后心房颤动(简称房颤)的预防作用。方法采用双盲、随机研究,将124例心脏手术者随机分为胺碘酮组(n=64),对照组(n=60)。胺碘酮组术前每天服用胺碘酮200mg,3次/天,至少7天,术后改为每天口服200mg,1次/天,直到出院。对照组则服用安慰剂,其剂量及服药方法与胺碘酮组相同。术前服用时间为13±7天,总剂量为4.8±0.9g。结果胺碘酮组术后房颤发生率、房颤时的心室率均较对照组低(23.4%vs41.7%,112±21次/分vs135±31次/分,P均<0.05),两组围术期并发症的发生率及死亡率均无显著差异。胺碘酮组的住院时间较对照组短(14.9±3.3天vs20.5±2.6天,P<0.05)。结论心脏手术围术期预防性服用胺碘酮是安全的,并且能显著降低术后房颤的发生率及房颤发生时的心室率,缩短住院时间。

Objective To assess the use of preoperative amiodarone against atrial fibrillation after cardiac surgery. Methods In this double-blind, randomized study, 124 patients were given either oral amiodarone （64 patients） or placebo （60 patients） for a minimum of seven days before elective cardiac surgery. Therapy consisted of 600 mg of amiodarone （ or placebo） per day for seven days, then 200 mg per day until the day of discharge from the hospital. The preoperative total dose of amiodarone（ or placebo）was 4.8 ± 0.9g over a period of 13 ± 7 days. Results Postoperative atrial fibrillation and the heart rate were all significantly less than that of placebo group（ 23.4% vs 41.7%, 112 ± 21 beats/min vs 135 ± 31 beats/min ,all P 〈0.05 ）. The hospitalization time in patients with amiodarone were fewer than that in patients with placebo （ 14.9 ± 3.3 days vs 20.5 ± 2.6 days,P 〈 0.05）. Perioperative complications and mortality between two groups were not significantly different. Conclusion Orally preoperative amiodarone in patients undergoing cardiac surgery is well tolerated and significantly reduces the incidence of postoperative atrial fibrillation and the duration of hospitalitation.