冠状动脉搭桥术后心房颤动高危者的胺碘酮预防试验

Amiodarone prophylaxis for atrial fibrillation of high-risk patients after coronary bypass grafting

目的对冠状动脉搭桥术(CABG)后患者发生心房颤动(AF)的危险性分级,对高危者给予胺碘酮预防,观察效果。方法 2008年10月至2009年7月CABG病人,符合研究条件的病例根据危险因素分组,有既往AF者,或有年龄>65岁、左房内径>45mm、射血分数<0.5、术后低氧血症中2个及以上危险因素者为高危组,有除既往AF史以外的其余4个危险因素中1个及无危险因素的病人为低危组。高危组随机分为胺碘酮组和常规组。除胺碘酮组在术后给予静脉口服序贯胺碘酮预防AF外,常规治疗三组均相同。比较三组的AF发生率,AF时心率,AF持续时间,AF负荷等指标。结果符合条件共161例。低危组96例,AF发生率28.1%;高危组65例,常规组33例,AF90.9%,死亡1例,2例出院时仍为持续AF;胺碘酮组32例,AF43.8%,全部复律。胺碘酮组AF发生率较常规组显著降低(P<0.01),AF心室率低于另两组(P<0.01)。低危组AF总持续时间和术后7天AF负荷显著小于另两组(P<0.05)。结论筛选CABG术后病人AF高危者,用胺碘酮预防可使AF发生率减低。

Objective To identify the high-risk patients with postoperative atrial fibrillation（AF） after coronary artery bypass grafting（ CABG）, and investigate whether prophylactic peri-operative administration of amiodarone could reduce the incidence of AF in high-risk group. Method From Oct 2008 to July 2009 , a total of 161 patients undergoing CABG were divided into high-risk group（ n = 65 ） and low-risk group （n = 96 ）according to the AF risk factors. The AF risk factors ： previous history of AF, age 〉 65 ys, left atrial dimension 〉 45 mm, ejection fraction 〈 0.50, postoperative hypoxemia. High-risk group was patient with previous history of AF, or two factors within the other 4 factors. Low-risk group was with no risk factor or only one factor within the latter 4 factors. High-risk patients received either prophylactic amiodarone （ n = 32） or routine therapy（ n = 33 ）. Amiodarone group was given intravenous plus oral amiodarone to prevent AF after CABG. Result Conform to the condition altogether 161 exanples, the incidence of postoperative AF in low-risk group, high-risk routine group and high-risk amiodarone group was 28.1% ,90.9% and 43.8%. Amiodarone reduced AF occurrence compared with routine group significantly （P 〈0.01 ）, and reduced heart rate of AF compared with other two groups（ P 〈0.01 ）. One patient died and two patients had persistent AF in routine group. The AF total persistent time and postoperative seven day AF burden of low-risk group was shorter than that of other two groups （ P 〈 0.05 ）. Conclusion The patient with highrisk of postoperative AF can be identified simply by its risk factors. The incidence of post-operative AF among high-risk patients is significantly reduced by prophylactic amiodarone treatment.