小剂量胺碘酮治疗急性心肌梗死伴高危快速型心律失常53例

Treatment of acute myocardial infarction companied arrhythmia with low dosage amiodarone

目的：探讨小剂量胺碘酮对急性心肌梗死（ＡＭＩ）并高危快速型心律失常患者的临床疗效。方法：１０５例ＡＭＩ并高危快速型心律失常患者随机分为２组；在ＡＭＩ常规治疗的基础上，胺碘酮组：０．２ｇ、每天３次，起效后减至每天１次口服，疗程３年。美托洛尔组：２５～５０ｍｇ，每天２次口服，疗程同上。结果：住院期间治疗组心肌梗死后心绞痛发生次数、静脉硝酸甘油剂量、用镇痛药次数均较美托洛尔组少（Ｐ＜０．０５，Ｐ＜０．０１），而左心室射血分数（ＬＶＥＦ）、左心室短轴缩短率（ＦＳ）、二尖瓣快速充盈期和心房收缩期二尖瓣血流速度（Ｅ／Ａ）均较美托洛尔组高（Ｐ＜０．０５，Ｐ＜０．０１）；泵衰竭发生率较美托洛尔组少（Ｐ＜０．０５）。随访３年，胺碘酮组发生不稳定型心绞痛、再发心肌梗死、心力衰竭均较美托洛尔组少（Ｐ＜０．０５）。结论：小剂量胺碘酮治疗ＡＭＩ并高危快速型心律失常患者作用可靠、不良反应轻微，可作为预防再发梗死、改善预后的抗心律失常药物。

Objective:To investigate the efficacy of low dosage of amiodarone in treating acute myocardial infarction(AMI)with arrhythmia Methods:105 cases of AMI with arrhythmia were randomly assigned into two groups In the base of routine AMI therapy,patients in amiodarone group were treated with amiodarone 0 2 g three times daily for 5 to 7 days,followed by 0 2 g once daily for three years Patients in control group were given 25 mg to 50 mg of metoprolol twice daily for three years Results:During in hospital period,the number of attacks of post infarction angina,consumption of intravenous nitroglycerin,and times of analgesics required in amiodarone group decreased significantly than that of control( P <0 05) LVEF,SF,and E/A in amiodarone group increased significantly than that of control group( P <0 05) During the subsequent follow up,the attacks of unstable angina,recurrent myocardial infarction,and heart failure in amiodarone group were significantly fewer Conclusion:Low dosage of amiodarone is effective in treating AMI complicated with tachyarrhythmia with mild adverse effects It can prevent recurrent infarction and improve prognosis