重症瓣膜病合并心房颤动患者瓣膜置换术体外循环中单次给予胺碘酮对窦性心律转复和维持的影响

Effect of Amiodarone on normal sinus rhythm in valve replacement surgery cardiopulmonary bypass of patients with severe valvular heart disease and atrial fibrillation

目的 观察体外循环中单次给予胺碘酮对重症瓣膜病合并心房颤动患者心律变化的影响。方法 选取ASAⅡ~Ⅲ级拟行心脏瓣膜置换术合并心房颤动的重症瓣膜病患者100例,随机双盲分为两组：组1（n=50）和组2（n=50）。记录初入手术室即刻的心律失常情况,组1在体外循环（CPB）中主动脉开放前5~10 min给予胺碘酮3 mg/kg,组2在CPB中主动脉开放前5~10 min给予0.9%氯化钠注射液15 m L,分别记录CPB前（T1）、开放主动脉后5 min（T2）、开放主动脉后15 min（T3）、开放主动脉后30 min（T4）、开放主动脉后1 h（T5）、开放主动脉后3 h（T6）、给药后24 h（T7）、给药后48 h（T8）、给药后72 h（T9）心电图,观察两组各时点窦性心律转复率。结果 组1开放主动脉后及给药后各时点转复窦性心律率均高于组2,差异有统计学意义（P〈0.05）。结论 重症心脏瓣膜病合并心房颤动的患者行瓣膜置换术CPB中单次给予胺碘酮能够提高CPB后窦性心律转复率,且作用可持续至术后72 h。

Objective To investigate the effect of intraoperative administration of Amiodarone on cardiac rhythm changes in cardiopulmonary bypass （CPB） of patients with severe valvular heart disease and atrial fibrillation. Methods 100 patients of ASA Ⅱ- Ⅲwith severe valvular heart disease and atrial fibrillation undergoing cardiac valve replace- ment surgery were selected and randomly divided into group 1 and group 2, each group had 50 cases. The arrhythmia was recorded in operating room at once. Patients in group 1 were given Amiodarone 3 mg/kg 5-10 min before aorta open in CPB, patients in group 2 were given 0.9% Sodium Chloride Injection 15 mL 5-10 min before aorta open in CPB. The electrocardiogram was observed before CPB （T1）, 5 rain （T2）, 15 min （T3）, 30 rain （T4）, 1 h （T5）, 3 h （T6） after aorta open and 24 （T7）, 48 （T8）, 72 h （Tg） after drug administration. The normal sinus rhythm rates were observed at above time-points in the two groups. Results The normal sinus rhythm rates in group 1 were higher than those of group 2 at time-points after aorta open and after drug administration, with statistically significant differences （P 〈 0.05）. Conclusion Amiodarone can enhance normal sinus rhythm rate after CPB in patients with severe valvular heart disease and atrial fibrillation underwent valve replacement surgery, its effects can last until 72 h after surgery.