胺碘酮与艾司洛尔治疗老年患者急性心肌梗死合并室性心律失常的短期疗效与安全性比较

Comparison of short-term efficacy and safety between amiodarone and esmolol treatment in elderly patients with acute myocardial infarction complicated with ventricular arrhythmia

目的 比较老年急性心肌梗死（AMI）合并严重室性心律失常患者静脉应用胺碘酮或艾司洛尔48 h内疗效及不良反应,为临床安全用药提供依据. 方法 2009年1月至2013年6月在中国医科大学附属盛京医院心脏内科连续住院治疗的老年AMI合并严重室性心律失常患者纳入研究,分为胺碘酮组与艾司洛尔组.胺碘酮组患者在10 min内静脉注射胺碘酮150 mg＋ 5％葡萄糖注射液20 ml后经微量注射泵静脉输注胺碘酮1 mg/min共6h,减量至0.5 mg/min静脉输注24～48 h,之后口服胺碘酮0.2g,3次/d,共7d.艾司洛尔组患者在1 min内静脉注射艾司洛尔注射液0.5 mg/kg后经微量注射泵静脉输注艾司洛尔0.1 mg/（kg·min）共6h,减量至0.05 mg/（kg·min）静脉输注24 ～ 48 h,之后口服美托洛尔25 mg,2次/d,共7d.胺碘酮组和艾司洛尔组静脉应用胺碘酮或艾司洛尔6h后仍有室速发作者,分别加用上述艾司洛尔或胺碘酮治疗方案.比较2组患者治疗48 h内有效率和不良反应发生率. 结果 胺碘酮组和艾司洛尔组48 h内有效率分别为92.1％（35/38）和75.0％（27/36）,组间差异有统计学意义（P=0.046）;不良反应发生率分别为39.5％（15/38）和19.4％（7/36）,组间差异无统计学意义（P =0.060）.胺碘酮组2例伴有心力衰竭患者静脉用药24 h后出现急性肝损伤,停药并对症治疗2周后肝功能恢复正常. 结论 静脉应用胺碘酮治疗老年患者AMI合并严重室性心律失常有效率优于艾司洛尔.胺碘酮与艾司洛尔均较安全.高龄AMI且伴心力衰竭者静脉应用胺碘酮时需密切监测肝功能,出现肝损伤需立即停药并给予对症治疗.

Objective To compare the efficacy and safety of intravenous application of amiodarone or esmolol in elderly patients with ventricular arrhythmia following acute myocardial infarction （AMI） within 48 hours,and provide reference for safe use of medication in clinical practice.Methods Elderly hospitalized patients with severe ventricular arrhythmia following AMI in department of Cardiology in Shengjing Hospital of China Medical University from January 2009 to June 2013 were enrolled into the study.The patients were divided into amiodarone group and esmolol group.The patients in amiodarone group received intravenous injection of amiodarone 150 mg in 5% glucose solution 20 ml within 10 minutes,then an Ⅳ infusion of amiodarone 1 mg/min was given by syringe pump for 6 hours,then an Ⅳ infusion of amiodarone 0.5 mg/min was given for 24-48 hours.After finishing the intravenous application,the patients were given amiodarone orally 0.2 g thrice daily for 7 days.The patients in esmolol group received intravenous infusion of esmolol 0.5 mg/kg within 1 minute,then a venoclysis of esmolol 0.1 mg/（kg · min）was given by syringe pump for 6 hours,then a venoclysis of esmolol 0.05 mg/（kg · min） was given for 24-48 hours.After finishing the intravenous application,the patients were given metoprolol orally 25 mg,twice daily for 7 days.The patient who still had ventricular tachycardia after intravenous application of amiodarone or esmolol for 6 hours in amiodarone group or esmolol group should receive the above-mentioned esmolol or amiodarone treatment,respectively.The efficacy and safety within 48 hours between the 2 groups were compared.Results The effective rate in amiodarone group and esmolol group within 48 hours were 92.1% （35/38） and 75.0 （27/36）,respectively （P =0.046）.The incidence of adverse reactions in the 2 groups were 39.5% （15/38） and 19.4% （7/36）,respectively （P =0.060）.Two patients who had accompanied heart failure in the amiodarone group developed acute liver injury 24 hours after intravenous application.Two weeks later,their liver function returned to normal after drug withdrawal and symptomatic treatment.Conclusions The effective rate of intravenous application of amiodarone was higher than that of esmolol in treatment for elderly patients with ventricular arrhythmia following AMI.Amiodarone and esmolol are relatively safe.The liver function should be monitored in the elderly AMI patients when intravenous application of amiodarone were given.Once liver injury occurs,the drug should be discontinued immediately and the symptomatic treatment should be given.