地尔硫卓预防肺切除术后房性心律失常的效果

Effects of diltiazem prophylaxis on incidence of atrial arrhythmias after pulmonary surgery

目的： 观察预防性应用钙离子拮抗剂地尔硫卓能否降低肺切除术后心房颤动（或）心房扑动及其并发症的发生率。方法： 从2007年-2011年接受肺叶切除患者341例，采用随机对照双盲试验，其中169例患者给予术前口服、术后进食后即开始口服地尔硫卓， 直至术后14 d；安慰剂组172例患者。观察的终点是对治疗期间持续房颤或临床症状明显的房性心律失常的治疗效果。结果： 在地尔硫卓治疗组房颤或房扑的发生率［10.6%（20/169）］较对照组［19.8%（36/172）］显著降低（P〈0.05）；房颤发生的患者中地尔硫卓治疗组的平均心率较安慰剂组也显著降低。但两组之间在术后主要并发症及住院时间均无显著差异。无明显的与口服地尔硫卓相关的并发症出现。结论： 预防性口服地尔硫卓可以显著降低胸外科手术后患者房性心律失常的发生率。

AIM： To evaluate whether early prophylaxis with calcium channel blocker reduces the incidence and morbidity associated with atrial arrhythmias after major thoracic surgery. METHODS： In this randomized, double-blinded and placebo-controlled study, 341 patients were given dihiazem or placebo orally before and immediately after lobectomy （169/172） and thereafter for 14 days. The primary end point with respect to efficacy was a sustained ≥ 15 rain or clinically significant atrial arrhythmia during treatment. RESULTS： Postoperative atrial arrhythmias incidence in the dihiazem group was significantly lower compared to the placebo group, with nearly a 50% reduction of the incidence of clinically significant arrhythmias. The maximal ventricular rate during AF in the diltiazem group was significantly lower than in the placebo group. No significant difference was observed in the incidence of postoperative complications and the length of hospital stay between groups. There were no serious adverse effects caused by diltiazem. CONCLUSION： Prophylactic diltiazem reduces the incidence of clinically significant atrial arrythmias in patients at high risk for this complication after major thoracic operations.