胺碘酮治疗老年充血性心力衰竭伴快速房颤的疗效观察

Efficiency of intravenous amiodarone in congestive heart failure patients with atrial fibrillation

目的：观察胺碘酮治疗老年充血性心力衰竭（CHF）伴快速心房纤颤（AF）的疗效。方法选择2012年9月至2013年9月在苏北人民医院住院治疗的老年CHF伴快速AF患者70例，纽约心脏联合会分级（NYHA）Ⅱ～Ⅳ级，心室率≥120次/min；随机分为胺碘酮组和去乙酰毛花苷组，每组各35例。在常规治疗基础上，胺碘酮组首次剂量给予胺碘酮150mg缓慢静注，随后1.5mg/min微量泵维持；去乙酰毛花苷组首次剂量给予去乙酰毛花苷0.4mg或0.2mg缓慢静注，1h后无效者追加0.2mg。观察用药后不同时刻的心室率变化、药物平均起效时间、复律成功比例、B型利钠肽（BNP）变化、不良反应及随访效果。结果两组患者用药后1，2，24h的心室率与用药前比较差异有统计学意义（P＜0.01），胺碘酮组用药后30min的心室率与用药前比较差异亦有统计学意义（P＜0.01）；用药后2h胺碘酮组患者心室率较用药前下降47%,去乙酰毛花苷组下降28%；胺碘酮组与去乙酰毛花苷组用药后30min，1h，2h，24h心室率间差异有统计学意义（P＜0.01）；胺碘酮组和去乙酰毛花苷组的治疗有效率分别为79.8%和72.3%（P＞0.05）；胺碘酮组和去乙酰毛花苷组的复律成功率分别为34.3%和8.6%（P＜0.01）；两组患者间BNP变化差异无统计学意义（P＞0.05）；出院3个月后随访，两组患者治疗后（口服药物包括可达龙、美托洛尔、地高辛）仍为AF的比率分别为60.0%（21/35）和82.9%（29/35）；而不良反应发生率分别为8.6%和11.4%（P＞0.05）。结论胺碘酮是治疗老年CHF合并AF有效的药物之一，副反应轻，使用安全。

ObjectiveTo determine the effect of intravenous amiodarone on the rapid ventricular rate in the patients with atrial fibrillation （AF） and congestive heart failure （CHF）.Methods Seventy elderly patients with AF and CHF [ventricular rate〉120beats/min, New York Heart Association （NYHA） classⅡ-Ⅳ] hospitalized in theNorthern Jiangsu People’s Hospital from September 2012 to September 2013 were recruited in this study. They were randomized into 2 groups： amiodarone group （n=35, loading dosage of 150mg followed by a dose of 1.5mg/min） anddeslanoside group （n=35, loading dosage of 0.4 or 0.2mg in slow injection, and more 0.2mg should be medicated if no effect occurred in 1h later）. The ventricular rate, mean response time, successful cardioversion ratio,brain natriuretic peptide （BNP） level, the adverse effects and follow-up outcomes were recorded after medication.Results The ventricular rate was significantly decreased in 1, 2 and 24h after treatment thanbefore inboth groups （P〈0.01）, even in 30 minin amiodarone group （P〈0.01）. In 2h after treatment, the ventricular rate was reduced by 47% inamiodarone groupand by 28%indeslanosidegroupwhen compared with the rate before treatment. Significant difference was found in therate between the2 groups in 30min, 1h, 2hand24h after treatment（P〈0.01）.The total effective rate on controlling rapid AF was 79.8% （amiodarone group）and 72.3% （deslanoside group） respectively （P〉0.05）. In 3 months after discharged from hospital, the ratio of persistent AFafter the medications （amiodarone, metoprorol and digoxin） was 60.0% （21/35） and 82.9% （29/35）, respectively, and the rate of adverse effect was 8.6% and 11.4%, respectively, in the 2 groups （P〉0.05）.Conclusion Amiodarone isof safety, rapid effect andmild adverse effect in treatment of CHF patients with coexisting AF.