索他洛尔联合普罗帕酮治疗小儿房性心动过速疗效探讨

Investigation into the effects of sotalol combined with propafenone in the treatment of pediatric atrial tachycardia

目的探讨索他洛尔联合普罗帕酮治疗小儿房性心动过速的疗效及安全性。方法对2009年2月至2010年5月于清华大学第一附属医院心脏中心小儿心内科诊断为房性心动过速(房速)的42例患儿(男19例,女23例,年龄7d至14岁)采用口服抗心律失常药物治疗,应用24h动态心电图及远程无线心电实时监测系统评价治疗效果,采用超声心动图评价患儿心脏功能,同时密切监测药物副反应的发生。结果接受索他洛尔单独用药21例次,无显著有效,有效20例(95.2%),无效1例(4.8%)。41例房速患儿最终接受索他洛尔联合普罗帕酮治疗,显著有效30例(73.2%),有效9例(21.9%),无效2例(4.9%)。索他洛尔有效剂量4.9～5.7mg(/kg·d),普罗帕酮有效剂量9～10.5mg(/kg·d)。持续性房速中5例(5/17例,29.4%)就诊时合并心动过速性心肌病,予以服用胺碘酮联合倍他乐克,其中1例显著有效,4例未达显著有效者均于用药后心功能明显改善,于心功能接近正常后改为服用索他洛尔联合普罗帕酮治疗。3例患儿口服胺碘酮3～8个月后发生甲状腺功能受损,停药后1个月内恢复正常。自无心动过速发作始持续用药6个月至1年,停药后随访31例显著有效患儿1～9个月,仅1例短阵房速患儿停药8个月后心动过速复发。结论索他洛尔可安全有效地用于治疗小儿心功能正常的房速,有效剂量为4.9～5.7mg(/kg·d);索他洛尔联合普罗帕酮治疗小儿房速效果明显优于索他洛尔单独用药,安全性良好;小儿短期应用胺碘酮还是比较安全的,而长时间应用(>3个月)易导致甲状腺功能受损,可作为房速合并心动过速性心肌病患儿的过渡用药。

Objective To evaluate the efficacy and safety of the combination use of sotalol with propafenone to treat pediatric atrial tachycardia.Methods A total of 42 children（male 19,female 23,aged 7 days～14 years）diagnosed with atrial tachycardia in our hospital were treated by oral anti-arrhythmic drugs.24-hour holter monitoring and wireless remote realtime monitoring system were used to evaluate the efficacy.Cardiac function was evaluated by echocardiogram.Side effects of drugs were closely detected during the whole process.Results Twenty-one cases were firstly treated by single sotalol,but no one was were completely cured,20 were partially cured（95.2%）,and 1 was ineffective（4.8%）.Forty-one cases were finally treated by sotalol plus propafenone,30 were completely cured（73.2%）,9 were partially cured（21.9%）and 2 were ineffective（4.9%）.The effective dose of sotalol was 4.9～5.7 mg/（kg·d）,and the effective dose of propafenone was 9～10.5 mg/（kg·d）.Five cases of incessant atrial tachycardia complicated by tachycardiomyopathy（5/17,29.4%）were treated by amiodarone plus metroprolol,1 was completely cured and the others＇ cardiac fuction were obviously improved after treatment although none of them were completely cured,they all reverted to sotalol plus propafenone while cardiac function became nearly normal.Injury of thyroid function happened in 3 cases after treatment of oral amiodarone for 3～8 months and all recovered during 1 month after withdrawing the drug.The therapy continued for 6 months to 1 year after disappearance of arrhythmia.During the 1～9 months of follow-up period after withdrawing drugs 31 cases were completely cured,while only 1 case of intermittent atrial tachycardia recurred at the 8th month after withdrawing the drug.Conclusion Sotalol is a safe and effective anti-arrhythmic drug which can be used to treat pediatric atrial tachycardia;the effective dose is 4.9～5.7 mg/（kg·d）;combination use of sotalol plus propafenone is obviously more effective with satisfactory safety than single use of sotalol;short-term use of amiodarone is safe for children,while long term use（ 3 months）might lead to thyroid function injury,and can be used as transitional drug for patients diagnosed with tachycardiomyopathy.