胺碘酮对体外循环后心脏复跳及自律性的影响

Effect of amiodarone on restoration of sinus rhythm in patients with atrial fibrillation after cardiopulmonary bypass

目的观察胺碘酮对体外循环术后心脏复跳及自律性的影响。方法择期二尖瓣置换的房颤患者64例随机分为三组,分别在体外循环期间静脉注射胺碘酮8mg/kg(A组),4mg/kg(B组)或等量生理盐水(C组)。观察转流时间、心脏复跳时间、自律性、临时心脏起搏及血管活性药物使用情况。结果与A、B组相比,C组的后并行时间和转流时间显著延长(P<0.01),自动复跳、复跳后窦律比例显著降低(P<0.05和P<0.01),停机后多巴胺使用量显著增加(P<0.01)。A组临时起搏器使用比例较其它两组显著增加(P<0.05)。各组复跳后窦律患者左房小于房颤患者(P<0.01),C组窦律患者左房小于其它两组(P<0.01)。结论体外循环术中心脏复跳前使用胺碘酮可以增加房颤患者心脏自动复跳的成功率,更好地维持窦性心律,稳定血流动力学,减少多巴胺用量及体外循环时间。

Objective To observe the effect of amiodarone on restoration of sinus rhythm in patients with atrial fibrillation after cardiopulmonary bypass （CPB）.Methods Sixty-four patients with atrial fibrillation undergoing selective mitral valve replacement were randomly divided into three groups. They received amiodarone 8 mg/kg,4 mg/kg or the same volume of normal saline during cardiopulmonary bypass,respectively. Bypass time,cardiac recovery time,rhythm,pacemaker and dopamine usage were recorded. Results Compared with the two amiodarone groups,the posterior parallel circulation time and bypass time were significantly prolonged （P0.01）,and the ratios of auto re-beat and restoration of sinus rhythm were significantly decreased,and dopamine usage was increased in the saline group （P0.05 and P0.01）. The pacemaker usage ratio in the group A was higher than that of the other two groups （P0.05）. The size of left atrium in patients with sinus rhythm was significantly smaller than those with atrial fibrillation （P0.01）,and the size of left atrium in patients with sinus rhythm in the group C was smaller than those of the amiodarone groups （P0.01）. Conclusion The use of amiodarone during CPB may increase the success rate of cardiac recovery,and maintain sinus rhythm better,and reduce dopamine usage and bypass time.