75岁以上高龄老年人阵发性心房颤动药物治疗的观察

Drug therapy of paroxysmal atrial fibrillation in the elderly above 75 years old

目的 :观察 75岁以上老年人阵发性房颤药物治疗效果及安全性。方法 :住院患者 2 6 4例 ,年龄 75～91岁 ,男 185例、女 79例。本次房颤发作持续时间≤ 7d。共记录 6 11次房颤发作 ,房颤起病 2 4h内自行转复130次 (2 1 3% )。将其余 4 81次房颤分为 6组 ,观察用药 4 8h的房颤转复及心室速率变化。结果 :房颤转复率在对照组、毛花甙丙组、胺碘酮组、普罗帕酮组、维拉帕米组和奎尼丁组分别为 7%、4 6 9%、71 7%、5 5 9%、32 7%和 73 6 % ;心室速率控制率分别为 4 %、83 6 %、84 9%、77 9%、78 8%和 11 3% ;总有效率以胺碘酮组和毛花甙丙组最高。当心室速率控制在 <90 min时 ,患者在 82 %的房颤发作中 ,自觉症状明显减轻或消除。各治疗组不良反应轻微。结论 :75岁以上阵发性房颤最初 2 4h自行转复率较高 ,药物治疗以速率控制为基本目标 ,以节律控制为理想目标 。

Objective:To investigate the effects and safeties of various agents in treatment on paroxysmal atrial fibrillation in the elderly above 75 years old Methods:264 in patients aged 75～91 years old (male 185 and female 79 ) with atrial fibrillation of less 7 days were selected for this study 611 times of atrial fibrillation were recorded, but 130 times (22 3%) of atrial fibrillation were auto converted to sinus rhythm The rest 481 times of atrial fibrillation were randomly divided into six groups for observation of rhythm conversion and rate control Results:The cardioversion rate for atrial fibrillation were 7%, 46 9%, 71 7%, 55 8%, 32 7% and 73 6% in group control, digitalis, amiodarone, propafenone, verapamil and quinidin respectively Ventricular rate control were 4%, 83 6%, 84 9%, 77 9%, 78 8%and 11 3%in those groups respectively The total effective rate was the highest in groups amiodarone and digitalis When the ventricular rate was controlled fewer than 90 beats per minute, the patients would complain of slighter or no discomfort No severe side effects were found in each group Conclusion:The auto conversion rate of paroxysmal atrial fibrillation was higher in the elderly above 75 years old within the first 24 hours after onset of atrial fibrillation For treatment of paroxysmal atrial fibrillation in the elderly rate control should be the basic aim and rhythm control should be the ideal aim Amiodarone and digitalis were agents of choicein this study