依布利特转复脑栓塞并心房纤颤的临床研究

Clinical research on ibutilide for immediate cardioversion of recent-onset cerebral embolism and atrial fibrillation

目的评价新型Ⅲ类抗心律失常药物依布利特转复脑栓塞并心房纤颤（房颤）患者的有效性和安全性。方法本研究选择脑栓塞并房颤持续1h-90d的患者40例，其中男24例，女16例，10min内静脉注射依布利特1mg，如给药结束10min后仍未转复为窦性心律，重复前述治疗1次。观察开始给药后90min内房颤的转复率及4h内的不良反应。结果①依布利特转复脑栓塞房颤的成功率高（77．5％，31／40）；②脑栓塞房颤的转复率与房颤的持续时间有关，持续时间低于24h的房颤转复率（89．29％，25／28）明显高于持续时间超过24h者（50％，6／12，P〈0．05）；③脑栓塞房颤的转复率与左心房直径呈负相关，左心房直径〈4．0cm患者的转复率（92％，23／25）明显高于左心房直径≥4．0cm患者的转复率（53．33％，8／15，P〈0．05）；④脑栓塞房颤的转复率与脑栓塞严重程度和基础疾病有关；⑤依布利特的不良反应：消化道症状，1例出现恶心（2．5％，1／40），1例发生非持续性单形室性心动过速，发生率为（2．5％，1／40），均未经特殊处理很快消失，未发现有低血压及长间歇。结论依布利特是一种转复房颤的抗心律失常药物，能有效、快速、安全的转复脑栓塞患者的心房纤颤。

Objective To judge the efficiency and safety of intravenous ibutilide for immediate cardioversion of recent-onset cerebral embolism and atrial fibrillation. Methods Fourty consecutive patients with atrial fibrillation（ onset with in 1 h-90 d） and cerebral embolism were selected to the group. Patients received ibutilide 1 mg Ⅳ over 10 min. If atrial fibrillation persisted ten minutes later,repeat the first loading. Results The rate of cardioversion of the ibutilide group was high for up to 77.5%. The conversion rate was higher in patients whose atrial fibrillation had persisted within 24 h than over 24 h （89.29% vs 50% ,P 〈0.05）. The efficiency was higher in patients whose left atrial diameter was below 4.0 cm than that over 4.0 cm（92% vs 53.33% ,P 〈 0. 05）. The rate of conversion was related to degree and area of cerebral embolism. Diaorder of digestion is adverse drug reaction of ibutilide. The most serious adverse effect of ibutilide was nonsustained monomiphic ventricular tachycardia. Conclusion Ibutilide is a safe and effective agent cardioversion of recent-onset cerebral embolism and atrial fibrillation.