华法林在经体表UCG检查“心房内未见血栓”的慢性房颤患者复律中的作用

Effect of Warfarin on Chronic Atrial Fibrillation in "Invisible Thrombus in Atria"

目的观察华法林在经体表UCG检查"心房内未见血栓"的慢性房颤患者复律中的作用。方法将60例需要复律且经体表UCG检查"心房内未见血栓"的慢性房颤患者随机分为治疗组及对照组,每组各30例。治疗组复律前常规口服华法林3mg/d抗凝治疗3周,使国际标准化比率维持在2～3;对照组房颤复律前不服华法林。两组均口服胺碘酮复律。3周未能复律或QTc>0.50ms者,即为复律失败,停服胺碘酮。治疗组复律成功后再继服华法林3mg/d4周。观察两组复律成功率、复律成功所需时间、胺碘酮总用量、不良反应。结果治疗组复律成功率为73.33%明显高于对照组的53.33%(P<0.05);且治疗组复律所需时间较对照组为短(212h±82hvs276h±101h,P<0.05);胺碘酮总用量较对照组为少(4.8g±2.1gvs7.2g±2.2g,P<0.05),未见栓塞不良反应。对照组复律后有1例发生脑栓塞。结论慢性房颤在复律前后尽管体表UCG检查"心房内未见血栓"应用华法林抗凝亦可提高房颤复律成功率及预防栓塞等并发症的发生。

Objective To study the effect of Warfarin on chronic atrial fibrillation in ＂invisible thrombus in atria＂. Methods Sixty patients （pts） with chronic atrial fibrillation and ＂invisible thrombus in atria＂ by external UCG were divided at random into two groups： Treatment group treated with Warfarin and amiodarone （n=30）, and control group treated with amiodarone （n=30）. The pts in treatment group took Warfarin for 3 weeks to keep the International Normalized Rate （INR）between 2 and 3. The pts in control group were not taken Warfarin. Amiodarone was used by oral way. After the success of cardioversion in therapy group, Warfarin was continued to be used 3 mg/d for 4 weeks. Results The rate of successful cardioversion （73.33%） in therapy group was higher than that （53.33 % ） in contrast group （P〈0.05）. The time for cardioversion （212 h±82 h） in therapy group was shorter than that in contrast group （276 h±101 h）. The total dosage of amidarone in therapy group was less than that in contrast group （4.8 g±2.1 g： 7.2 g±2.2 g）. Conclusion Warfarin could raise the rate of cardioversion in chronic atrial fibrillation with invisible thrombus in atria.