顿服普罗帕酮治疗非瓣膜性阵发性心房颤动疗效观察

Effect of Oral Propafenone on Reversing Paroxysmal Atrial Fibrillation with No Rheumatic Disease

目的研究顿服普罗帕酮转复非瓣膜性阵发性心房颤动(房颤)的临床疗效和安全性。方法有症状的阵发性心房颤动患者78例,无严重心肌缺血、充血性心力衰竭和电解质紊乱,并排除瓣膜性心脏病和肝、肾功能损害。随机分为普罗帕酮组和毛花甙C组:普罗帕酮组一次顿服普罗帕酮负荷量300-600 mg(6-8 mg／kg);毛花甙C组静推西地兰0．4 mg,4 h后仍为心房颤动则追加0．2 mg。在心电监护下密切观察患者心律、速率、血压及症状变化,记录从给药到心房颤动转复的时间及转复瞬间心电图情况。比较两组患者4 h、8 h和12 h内房颤转复率及转复时间。结果普罗帕酮组39例,其中4 h内转复21例(53．85％);毛花甙C组共39例,其中4 h内转复10例(25．64％)。4 h内普罗帕酮组房颤动转复率明显高于毛花甙C组(P<0．05),4 h内平均转复时间亦有明显差异(P<0．05)。结论对于不伴有心力衰竭、严重心肌缺血的非瓣膜性阵发性心房颤动,顿服普罗帕酮是简便、安全、有效的方法。

Objective To evaluate the effects of orally administered propafenone on reversing paroxysmal atrial fibrillation and its safety in non valvular heart disease. Methods 78 patients with paroxysmal atrial fibrillation were divided into propafenone group and lanatoside C group. Subjects with congestive heart failure, serious myocardial ischemia, valvular heart disease, electrolyte disturbance, impairment of hepatic function and renal function were excluded. 39 patients were performed oral propafenone 300 - 600 mg（6 - 8 mg/kg） in a single dose. 39 patients were given intravenous lanatoside C 0.4 mg as control Close observations of cardiac rhythm, heart rate, electrocardiogram, blood pressure and symptoms under heart monitor were performed and the times from taking the drug to reversing the atrial fibrillation were recorded. Result 39 patients in oral propafenone group were reversed within 4 hours（53.85% ）. In the group of intravenous lanatoside C, 10 patients were reversed within 4 hours（25.64% ）. In the first 4 hours, the success rate of reversing atrial fibrillation and average reversal time were significantly higher in the propafenone group than those in lanatoside C group （P 〈 0.05）. Conclusion Oral propafenone is a convenient safe and efficiency method for reversing paroxysmal atrial fibrillation with no congestive heart failure, serious myocardial ischemic and valvular heart disease.