艾司洛尔与毛花苷控制快速房颤心室率的疗效及安全性比较

Comparison of immediate therapeutic effect and safety between esmolol and lanatoside in controlling ventricular rate for patients with rapid atrial fibrillation

目的:比较艾司洛尔与毛花苷控制快速心房颤动心室率的即时疗效及安全性。方法:72例快速心房颤动患者,心室率≥120次/min,被随机分为艾司洛尔组、毛花苷组各36例。艾司洛尔组首次剂量给予0.5mg/kg,1min静注,观察5min,若心室率仍>100次/min或下降<20%,则追加0.5mg/kg,同时以0.05mg·kg-1·min-1微量泵起始维持,维持量最大可加至0.3mg·kg-1·min-1;毛花苷组首次剂量给予毛花苷0.4mg或0.2mg缓慢静注,若心室率仍>100次/min或下降<20%,可追加0.2mg。记录药物起效时间及不良反应。结果:艾司洛组平均起效时间显著低于毛花苷组[(5.6±3.1)min比(39.2±8.7)min](P<0.01);两组患者用药后心室率均明显降低(P<0.05或<0.01),用药2h后艾司洛尔组心室率下降幅度显著大于毛花苷组(39%比29%,P<0.05);两组总有效率,不良反应发生率均无统计学差异(P>0.05)。结论:静脉应用艾司洛尔作用迅速,安全有效,可作为控制快速心房颤动心室率的首选治疗。

Objective：To compare the immediate therapeutic effect and safety between esmolol and lanatoside in controlling ventricular rate for patients with rapid atrial fibrillation.Methods：A total of 72 patients with rapid atrial fibrillation （ventricular rate ≥120 beats/min）were randomly and equally divided into esmolol group and lanatoside group.Esmolol group received first dosage of 0.5 mg/kg intravenously for 1 min,then were observed for 5 min,if ventricular rate still 〉100 beats/min or decreased 〈20%,the 0.5 mg/kg esmolol was appended,meanwhile main-tained by 0.05mg·kg^-1 ·min^-1 via micro pump at first,maintenance dose can increase to a maximum 0.3mg· kg^-1 ·min^-1;lanatoside group received first dosage of 0.4mg or 0.2mg slow intravenous injection,if ventricular rate still 〉100 beats/min or decreased〈20%,the another 0.2mg was appended.The onset time and adverse reactions were recorded after administration.Results：Compared with lanatoside group,there was significant reduction in mean onset time [（39.2±8.7）min vs.（5.6±3.1）min]in esmolol group,P〈0.01;compared with before administration,there was significant decrease in ventricular rate in two groups after administration,P〈0.05 or〈0.01. On 2h after administration,compared with lanatoside group,there was significant increase in decreasing range of ventricular rate （29% vs.39%）in esmolol group,P〈0.05. The total effective rate and adverse reaction rate was no significant difference （P〉0.05）between two groups.Conclusion：Intravenous using esmolol is efficient and safe,and it can be regarded as preferred therapy to control ventricular rate in patients with rapid atrial fibrillation.