盐酸胺碘酮治疗慢性房颤的临床研究

Clinical treatment of chronic atrial fibrillation with amiodarone hydrochloride

目的：探讨盐酸胺碘酮（AD）治疗慢性房颤的最小维持剂量及其血药浓度变化与临床疗效。方法：住院治疗的慢性房颤患者40例，给药前均作心电图（ECG）、甲状腺激素水平、胸片、肝肾功能等检查，并经常规抗凝治疗后给予盐酸胺碘酮复律，维持窦性心律后渐减至最小维持量（50—100mg·d^-1）；用RP—HPLC法定期检测血清AD和去乙基胺碘酮（DAE）浓度，同时密切观察临床疗效及药品不良反应。结果：AD50～100mg qd维持3、6、12个月，慢性房颤患者窦性维持率分别为85．0％、91．2％、82．6％；患者血清AD和DEA浓度波动范围大，而血清AD与DEA浓度之和的变化相对较小。结论：AD治疗慢性房颤的最小维持量可为50～100mg·d^-1，长期口服无严重不良反应，血清AD、DEA及浓度之和可作为有效血药浓度的监测指标。

Objective： Although many researchers have reported the clinical use of amiodarone hydrochloride （AD） on the remission of chronic atrial fibrillation, there is no reliable one to assure the exact dosage. We examined a practical therapy to detect minimum maintenance dose of AD on chronic atrial fibrillation, and to investigate the related plasma concentration to clinical efficacy. Methods： Forty patients with chronic atrial fibrillation were assigned to conventional anticoagulant therapy and then AD as chemical cardioversion medicine. Once restored to normal sinus rhythm, AD was dropped to a minimum maintenance dose （50 -100 mg＇di）. An RP-HPLC method was regularly used to measure serum amiodarone and desethyl amiodarone （DAE） concentrations. Results： By giving AD at a maintenance dose of AD for 3, 6 and 12 months, patients＇ sinus rhyhmy rates reached 85.0%, 91.2% and 82.6%, respectively. During the same period, serum AD or DEA concentration varied greatly, whereas the concentration of serum AD plus DEA fluctuated slightly. Conclusion： Reliable results were approached at a minimum maintenance dose of AD at 50 - 100 mg.d^-1 in treating chronic atrial fibrillation, and serious adverse reactions were not found in long-term follow up. Serum concentrations of AD and DEA provided a reliable efficacy index for amiodarone in chronic atrial fibrillation therapy.