伊布利特转复房扑及房颤的临床研究

Clinical Study of Ibutilide in TermInation of Atrial Fibrillation and Atrial Flutter

目的探讨静脉应用伊布利特转复心房颤动/心房扑动的有效性。方法筛选持续时间在90 d以内,符合入选条件的阵发或持续性房颤/房扑患者共36例,随机分为伊布利特组和可达龙组各19例和17例。伊布利特组体重≥60 kg者,首剂1.0 mg稀释于0.9%氯化钠注射液20 mL静脉推注;体重<60 kg者,首剂0.01 mg/kg,如无效10 min后再给予1.0 mg/kg或0.01 mg/kg;可达龙组,首剂150 mg稀释于0.9%氯化钠注射液20 mL静脉推注,如无效10 min后再给予150 mg。结果伊布利特组和可达龙组的总转复率分别为63.16%VS 35.29%(P<0.05);伊布利特组房扑的转复率明显高于可达龙组75.0%VS 33.3%(P<0.01),伊布利特组房颤的转复率明显高于可达龙组60%VS 35.71%(P<0.05),差异均有统计学意义。伊布利特组和可达龙组平均转复时间分别为(28.13±11.46)min VS(50.01±14.72)min,差异有统计学意义(P<0.01)。两组均能有效降低房颤/房扑的心室率,但组间比较差异无统计学意义。结论伊布利特是一种起效快,对房扑、房颤患者转复率高的药物,其疗效优于可达龙,但需在严格监控下进行。

Objective To investigate the efficacy of intravenous ibutilide for conversion of atrial fibrillation （AF） and flutter （AFL） to nomlal sinus rhythm. Methods Thirty- six consecutive patients with AF or AFL were included. The duration of arrhythmia was less than 90 days. Ibutilide group（ 19 patients） and amiodarone group （ 17 patients） were assigned randomly. Patients in ibutilide group received 1.0 mg ibutilide when body weight ≥60 kg or 0.01 mg/kg when body weight 〈 60 kg; treatment was repeated if atrial fibrillation or flutter was not converted 10 min after the first dosage. Patients in the amiodarone group received 150 mg amiodarone, followed by a further 150 mg if atrial fibrillation or flutter persisted 10 min after the first dosage. Two drugs were diluted by 20 mL of 0.9% sodium chloride and injected intravenously within 10 min. Results The overall conversion rate on AFL and AF of the ibutilide group was significantly higher than that of the amiodarone group （63.16% VS 35.29%, P 〈 0.05）. The conversion rate on AFL of the ibutilide group was significantly higher than that of the amiodarone group（75.0% VS 33.3%, P 〈 0.01 ）, The conversion rate on AF of the ibutilide group was significantly higher than that of the anfiodarone group （60.0% VS 35.71 %, P 〈 0.05）. Ibutilide had a significantly fast the mean converting time than amiodarone （28.13 ± 11.46） min vs （50.01 ± 14.72） min （ P 〈 0.01 ）. Both two drugs decreased ventrieular rate, but there was not significant difference at group comparison. Conclusion Ibutilide is a rapid and effective drug with high rate of conversion for atrial fibrillation and atrial flutter, which is more effective than amiodarone. The administration should be carried out under strict eleetrocardio monitoring.