静脉应用胺碘酮、普罗帕酮和毛花甙C治疗阵发性室上性心动过速临床观察

Clinical Study of Intravenous Amiodarone,Propafenone and Lanatoside C on Reversing Paroxysmal Supraventricular Tachycardia

目的 对比研究静脉应用胺碘酮、普罗帕酮和毛花甙C治疗阵发性室上性心动过速的临床疗效和安全性。方法新近发作(24h之内)阵发性室上性心动过速病人68例,随机分为三组:胺碘酮组 23人,普罗帕酮组23人,毛花甙C组22人,分别静脉给予胺碘酮、普罗帕酮和毛花甙C治疗,在心电监护下观察心电、血压及症状变化,记录从用药开始到转复为窦性心律的时间。比较三组4h的转复率和转复时间。结果 4h普罗帕酮组转复21例(91.3％),转复时间34.8±19.9min;胺碘酮组转复15例(65.2％),转复时间37.1±22.3min;毛花甙C组转复10例(45.5％),转复时间92.9±47.5min。普罗帕酮组与胺碘酮组转复率均明显高于毛花甙C组(均P<0.01),而普罗帕酮组优于胺碘酮组(P<0.05)。普罗帕酮组与胺碘酮组在转复时间方面无显著差异(P>0.05),二者转复时间均短于毛花甙C组(P<0.01)。普罗帕酮组出现副作用2例。结论 治疗阵发性室上性心动过速疗效以普罗帕酮为最好,其次为胺碘酮,而毛花甙C疗效欠佳。

Objective To evaluate the efficacy and safety of intravenous (IV) amiodarone, propafenone and lanatoside C on reversing paroxysmal supraventricular tachycardia (PSVT). Methods 68 recent-onset (Less than 24 hours) patients suffering from PSVT were randomly divided into 3 groups:23 patients treated with amiodarone, 23 patients treated with propafernone and 22 patients treated with lanatoside C. 4-hour-close observation of EKG,blood pressure and symptoms under heart monitor was performed, and the time from receiving the drugs to reversing PVST to sinus rhythm was recorded. Results 21 patients on propafenone were reversed to sinus rhythm in 4 hours(82. 6%). The reversal time was 34. 8±19. 9min. 15 patients on amiodarone were reversed(65. 2%),the reversal time 37. 1±22. 3min. In the group of lanatoside C,only 10 patients were reversed(45. 5%) ,the reversal time 92. 9±47. 5min. The success rate of reversing PSVT was higher in the propafenone group and the amiodarone group than in the lanatoside C group(both P<0. 01),while the propafenone group's prior to the amiodarone group's(P<0. 05). As to the average reversal time, there's no difference between the amiodarone group's and the propafenone group's (P>0. 05),and both of them were shorter than the lanatoside C group's(P<0. 01). Adverse effects were encountered only in propafenone group;1 case with worsened arrhythmia and 1 with congestive heart failure. Conclusion Either propafenone or amiodarone given intravenously is a prompt,convenient and effective method for reversing PSVT, but propafenone prior to amiodarone. Lanatoside C was not so good.