房颤或房扑患者行心内直视手术静脉注射胺碘酮及美托洛尔对心律的作用

Intravenous amiodarone against atrial fibrillation or flutter after CPB in open heart surgery

目的比较观察术前存在房颤或房扑患者行心内直视手术在主动脉开放后静脉注射胺碘酮或美托洛尔对患者心律的作用。方法选择术前存在房颤和房扑拟行心内直视手术患者68例,随机分为三组:胺碘酮组(A组,23例),在主动脉开放后,自主心跳已恢复,给予胺碘酮150mg静脉推注,其后10mg·kg-1.d-1维持;美托洛尔组(B组,23例),在主动脉开放后,自主心跳已恢复,给予美托洛尔2mg静脉推注,其后美托洛尔1mg/h总量10mg;对照组(C组,22例),在主动脉开放后静注安慰剂。监测ECG、桡动脉压(ASP)、中心静脉压(CVP)、心脏指数(CI),随访术后心律转复情况。结果A组和B组不增加心律转复成功率,但与C组比较HR较慢(P<0.01),CI较高(P<0.01),并且ICU滞留时间较短(P<0.01),A组和B组相比差异无统计学意义。转复率与房颤病史密切相关。结论房颤或房扑患者在心内直视手术中,主动脉开放后静脉给予胺碘酮或美托洛尔虽然都不增加心律转复成功率,但能更好地控制心室率,而达到更稳定的血流动力学效果。

Objective To observe the effects of intravenous amiodarone or β-blockers on open heart surgery patients with atrial fibrillation（AF） or flutter. Methods Sixty-eight patients with AF under open heart surgery were randomly divided into three groups. After aortic clamp was removed, if AF still existed, cardioversion was performed in those patients. The patients in group A were administrated bolus of 150 nag amiodarone after aortic clamp was removed, which was followed with 10 mg· kg^-1·d^-1. The patients in group B were administrated bolus of 2 mg metoprolol after aortic clamp was removed, which was followed with 1 mg/h （total dose 10 mg）. The patients in group C were given placebo as the control. The data of hemodynamics and ECG were monitored and recorded. Results No difference was noted in baseline variables. The dysnythmias in 16 patients could be converted to sinus rhythm. The chance of sinus rhythm recovery had no significant difference among three groups. Heart rate was slower in group A and group B （P〈0. 01）, but CI was higher （P〈0.05） compared with that in group C. Patients in group A and group B had shorter time to stay in ICU because of more stable hemodynamics. Conclusion Intravenous amiodarone or metopolol after CPB in open heart surgery could not increase the chance of conversion of AF. But it helped to achieve more stable hemodynamics.