小剂量口服胺碘酮在心脏瓣膜疾病合并心房颤动患者围术期的应用

Perioperative application of small-dose oral amiodarone in patients with preoperative atrial fibrillation undergoing cardiac valve surgery

目的评估围术期口服胺碘酮对心脏瓣膜疾病合并心房颤动患者术后心房颤动心律的转复和窦性心律维持,以及术后并发症的影响。方法 78例心房颤动且择期行心脏瓣膜手术的患者被分为试验组(38例)和对照组(38例)。试验组开始口服胺碘酮每天2次,每次200 mg至术后第3天,术后第4天至出院前胺碘酮剂量改为每天1次,每次200 mg。对照组以安慰剂代替胺碘酮,服药时间、剂量和方法同实验组。比较两组术后窦性心律的转复和维持、有无低心排血量综合征、心律失常发生及类型、重症监护病房停留时间、住院时间、出院时心房颤动患者的心律和心室率,及术前、术后患者肝功能、甲状腺功能的变化,有无发生肺纤维化。结果术后两组比较,试验组窦性心律患者比例在手术复跳时(39.4%vs.10.5%,P<0.01)、出院前(46.7%vs.2.6%,P<0.01)及术后1个月(36.8%vs.2.6%,P<0.01)均高于对照组,差异有统计学意义。试验组与对照组比较,术后快速性心房颤动(15.8%vs.31.6%,P<0.05)、发作时心室率[(136.5±25.2)次/min vs.(158.6±30.9)次/min,P<0.05]及室性心律失常(7.9%vs.18.4%,P<0.05)低于对照组,差异有统计学意义。试验组重症监护病房停留时间[(40.9±11.2)h vs.(58.5±13.8)h,P<0.05)]、心房颤动患者出院时心室率[(74.2±8.4)次/min vs.(91.7±10.2)次/min,P<0.05]均小于对照组,差异有统计学意义。两组患者术后无死亡,无肝功能及甲状腺功能异常及无肺纤维化。结论行心脏瓣膜置换或整形手术的心房颤动患者围术期口服胺碘酮可明显提高患者术后窦性心律转复率、维持窦性心律时间、降低快速心房颤动及室性心律失常发生率,对心室率的控制满意,减少重症监护病房入住时间,无明显不良反应。

Objectives To evaluate the effect of perioperative small-dose oral amiodarone on postoperative outcomes in patients with preoperative atrial fibrillation （AF） after cardiac valve surgery.Methods Totally 78 patients with valvular heart disease and AF performed cardiac valve surgery were randomly divided into trial group （n=38） and control group （n=38）.Trial group received routine cardiac valve surgery as control group did except for a perioperative prescription of oral amiodarone of 200 mg,twice a day,from admission to the 3rd day after surgery,then 200 mg oral amiodarone once a day from the 4~ day after surgery to discharge.The incidences of conversion from atrial fibrillation to sinus rhythm,low cardiac output,rapid AF and ventricular arrhythmias,duration of mechanical ventilation,duration of intensive care unit （ICU） stay,duration of hospital stay,rhythm and ventricular rate in patients with AF at discharge were compared between the two groups.The incidences of thyroid and liver dysfunctions,and pulmonary fibrosis were also monitored before and after surgery.Results The proportions of patients with sinus rhythm was significantly higher at heart rebeating after surgery （39.4% vs.10.5%,P〈0.01）,at discharge （46.7% vs.2.6%,P〈0.01） and one month after surgery （36.8% vs.2.6%,P〈0.01） in trial group than those in control group.Compared with patients in control group,incidence of rapid AF （15.8% vs.31.6%,P〈0.05）,average ventricular rate of AF onset [（136.5±25.2） beats/min vs.（158.6±30.9） beats/min,P〈0.05],and ventricular arrhythmias （7.9% vs.18.4%,P〈0.05） in trial group were significantly lower.Duration of ICU stay [（40.9±11.2） h vs.（58.5±13.8） h,P〈0.05] and ventricular rate of AF at discharge [（74.2±8.4） beats/rmin vs.（91.7±10.2） beats/min,P〈0.05] in trial group were significantly shorter than those in control group.The mortality was zero,and none presented thyroid and liver dysfunctions or pulmonary fibrosis in both groups.Conclusions Perioperative application of small-dose oral amiodarone can obviously increase postoperative sinus rhythm conversion rate in patients with preoperative AF after cardiac valve surgery,and prolong the maintenance of sinus rhythm.It can also reduce the incidences of tachyarrhythmia and ventricular arrhythmias,shorten duration of ICU stay and control average ventricular rate of AF at discharge without obvious side effects.