围手术期使用胺碘酮对心房颤动转律的研究

Study of Prevention of Atrial Fibrillation by Perioperative Application of Amiodarone

目的探讨围手术期使用胺碘酮对二尖瓣置换手术患者心房颤动(房颤)的转复和维持窦性心律的作用。方法40例行二尖瓣置换手术房颤患者随机分为2组:胺碘酮组和安慰剂组,每组20例。胺碘酮组术前3 d开始胺碘酮200 mg口服,3次/d,术后当天通过微量输液泵持续静脉输注600 mg胺碘酮,能进食后改为胺碘酮200 mg口服,3次/d;1周后改为200 mg口服,2次/d;再1周后改为200 mg口服,1次/d,一直维持。安慰剂组以安慰剂代替胺碘酮,服药时间和方法同胺碘酮组。观察2组患者术后房颤转复率I、CU监护时间、住院时间及窦性心律维持情况。结果胺碘酮组房颤转复率明显高于安慰剂组(65%vs 30%,P<0.05)。随访6个月,胺碘酮组维持窦性心律明显优于安慰剂组(70%vs 0,P<0.05),而ICU监护时间和住院时间较安慰剂组缩短[(1.8±1.7)d vs(2.8±1.5)d,(11.3±2.4)d vs(13.4±3.2)d,P均<0.05]。结论胺碘酮可以有效地将二尖瓣置换手术患者的房颤心律转复为窦性心律,缩短ICU监护时间和住院时间,并且在术后维持窦性心律方面疗效显著。

Objective To explore the preventive effect of perioperative application of amiodatone on postoperative atrial fibrillation and holding sinus rhythm after mitral-valve replacement. Methods Forty patients who underwent mitral-valve replace surgery were randomly divided into two groups. Amiodarone group （n=20） was given oral amiodarone at 200 mg by three times per day for 3 days before operation,and intravenous amiodarone by microinfusion pump at 600 mg on the operation day. The next day they were give oral amiodarone at 200 mg by three times per day for 7 days,then 200 mg twice per day for a week followed by 200 mg once per day continuously. Control group （n= 20） was given placebo instead of amiodarone. The incidence of sinus rhythm and holding time in amiodarone group were assessed and compared with the control group. The length of staying in ICU and in hospital was also observed. Results The incidence of postoperative sinus rhythm in the amiodarone group was significantly higher than that in the control group （65% vs 30% P〈0.05）. The holding time of sinus rhythm in amiodarone group was longer than that in control group in six months follow-up（70% vs 0,P〈0.05）. The time staying in ICU and hospital of the amiodarone group shorter than that of the control group[（1. 8± 1. 7）days vs （2. 8±1.5）days,（11. 3±2. 4）days vs （13. 4±3.2）days,all P〈0. 053. Conclusion Amiodarone could significantly reduce the incidence of postoperative atrial fibrillation in patients undergoing mitral-valve replace surgery, shorten the length of stay in ICU and in hospital. And the better effect on holding sinus rhythm could be achieved after operation.