胺碘酮治疗急性心肌梗死并发房颤的临床疗效观察

Clinical Efficacy of Amiodarone in the Treatment of Acute Myocardial Infarction Complicated by Atrial Fibrillation

目的探讨胺碘酮治疗急性心肌梗死(AMI)并发房颤的方法及疗效。方法将2008年5月至2011年5月入住我科的120例急性心肌梗死并发房颤患者随机地均分为对照组与观察组两组。对照组(n=60)采用0.4mg西地兰,将其溶入至10mL浓度分数为5%的葡萄糖溶液中,于5min之内静脉推注完毕;观察组(n=60)采用25-100mg的胺碘酮进行缓慢静脉推注,然后以0.5-1mg/min的速度进行持续静脉滴注,直至转为窦性心律。对两组患者心电功能及生存质量进行对比。结果①两组患者最后均转复为窦性心律,且经治疗后两组患者心室率较治疗前均具有显著的统计学差异(P<0.01),但是组间不存在统计学差异(P>0.05);②上述两组患者在房颤转复时间、药物用量、房颤复发率等方面均存在显著的统计学差异(P<0.01);③观察组治疗后的左室射血分数(LVEF%)、左室舒张期末内径(LVDd)、HR、室性期前收缩[M(QR)]以及房性期前收缩[(QR)]较对照组具有显著的统计学差异(P<0.01);④对照组出现不良反应(如恶心、呕吐、血压下降等)的比率(38.3%)要明显高于观察组(15.0%),且二者具有显著的统计学差异(P<0.01)。结论静脉推注胺碘酮治疗急性心肌梗死并发房颤的临床治疗疗效明显,房颤时间明显缩短,胺碘酮用量发生明显减少,且能够显著改善患者的心功能状态、心功能指标、稳定心律,在很大程度上提高患者的治疗后的生存质量,值得在临床治疗AMI并发房颤中加以推广并应用。

Objective To explore the methods and efficacy of amiodarone in the treatment of acute myocardial infarction（AMI） complicated by atrial fibrillation.Methods 120 cases of patients with acute myocardial infarction complicated by atrial fibrillation were randomly divided into two groups of the control group and the observation group.The control group（n = 60）was gven the 0.4mg cedilanid,with adding to10mL concentration scores of 5% glucose solution,after 5min intravenous bolus;observation group（n=60）was given 25 - 100mg of amiodarone slow intravenous bolus,then given 0.5 - 1mg/min the continuous infusion until sinus rhythm.ECG function and quality of life of two groups of patients were compared.Results ① two groups of patients ultimately fell cardioversion to sinus rhythm,and after the two groups of patients with ventricular rate after treatment than before treatment were statistically significant differences（P0.01）,but there is no statistically significant difference between the groups（P 0.05）;②of the two groups of patients in atrial fibrillation cardioversion time,drug dosage,atrial fibrillation recurrence rate and so there are statistically significant differences（P0.01）;③observation group therapy Left ventricular ejection fraction（LVEF%）,left ventricular end-diastolic diameter（LVDd） before HR ventricular contraction [M（QR）] and atrial contraction（QR）] compared with the control group with significant statistical learning differences（P0.01）;④adverse reactions（such as nausea,vomiting,decreased blood pressure,etc.） the ratio of（38.3%） in the observation group（15.0%） was significantly higher than the control group,and both have a significant statistical learning differences（P0.01）.Conclusion Intravenous bolus amiodarone obvious clinical treatment in acute myocardial infarction complicated by atrial fibrillation,atrial fibrillation was significantly shortened,the amiodarone dosage occurred significantly reduced,and can significantly improve the patient＇s heart function status,cardiac function indicators,stable heart rate,greatly improve the treatment of patients quality of life,it is worth to be promoted and applied in the clinical treatment ofAMI atrial fibrillation.