伊布利特与胺碘酮在心房颤动患者中的疗效比较

Comparison in curative effects between ibutilide and amiodarone in patients with atrial fibrillation

目的比较伊布利特与胺碘酮对行射频消融术心房颤动（房颤）患者的疗效。方法选择于2012年10月~2014年10月间在武警总医院接受射频消融术治疗的房颤患者72例,男性49例,女性23例。回顾分析病历资料,将接受伊布利特治疗的患者纳入观察组（36例）,胺碘酮治疗的患者纳入对照组（36例）。两组患者的基线资料差异无统计学意义（P均〉0.05）,具有可比性。两组均行射频消融术,同时对照组应用胺碘酮,10 min内缓慢静脉推注完,若未复律则30 min后重复给药1次。观察组仅应用伊布利特。比较两组治疗后复律时间、QT间期及转复成功率及舒张早期充盈峰速度（E峰）、舒张晚期充盈峰速度（A峰）、左室舒张末期直径（LVEDD）和左室射血分数（LVEF）和超敏C反应蛋白（hsCRP）、白介素-8（IL-8）、白介素-6（IL-6）、N末端脑利肽前体（NT-pro BNP）水平。结果与对照组比较,观察组复律时间缩短[（46.77±9.56）min vs.（29.01±5.73）min],QT间期延长[（0.44±0.05s vs.（0.53±0.08）s],转复成功率升高（65.15%vs.89.39%）,差异有统计学意义（P均〈0.05）。观察组较对照组治疗后的E峰、LVEDD、LVEF水平升高,A峰水平降低,[（72.62±8.92）cm/s vs.（60.52±7.32）cm/s],[（58.34±5.73）mm vs.（51.32±4.99）mm],[（67.29±7.62）%vs.（59.56±6.15）%],[（55.58±6.65）cm/s vs.（68.42±8.14）cm/s],差异有统计学意义（P均〈0.05）。观察组患者伊布利特治疗后的血清hs-CRP、IL-6、IL-8及NT-pro-BNP水平均明显低于对照组,[（37.11±6.32）mg/L vs.（67.27±7.51）mg/L],[（60.17±5.45）μg/L vs.（87.58±7.21）μg/L],[（84.44±5.21）μg/L vs.（121.31±8.57）μg/L],[（89.27±7.33）pg/ml vs.（142.7±13.29±8.57）pg/ml],差异有统计学意义（P均〈0.05）。结论伊布利特较胺碘酮治疗心房颤动患者复律效果好,心功能及炎症指标均改善。

Objective To compare the curative effects between ibutilide and amiodarone in patients with atrial fibrillation （AF） undergone radiofrequency ablation （RFA）. Methods The patients （n=72, male 49 and female 23） were chosen from Oct. 2012 to Oct. 2014. After analyzing retrospectively their disease history materials, the patients treated with ibutilide were included into observation group （n=36） and those treated with amiodarone, into control group （n=36）. The difference in baseline materials had no statistical significance between 2 groups with comparability （all P〉0.05）. RFA was given to 2 groups, and at the same time control group was given amiodarone and observation was given ibutilide. The duration of AF conversion, QT interval, AF conversion success rate, early- diastolic fast filling velocity （peak E）, late-diastolic fast filling velocity （peak A）, LVEDd, LVEF, high-sensitivity C-reactive protein （hs-CRP）, interleukin-8 （IL-8）, interleukin-6 （IL-6） and NT-proBNP were compared between 2 groups after treatment. Results Compared with control group, duration of AF conversion was shortened [（46.77±9.56） rain vs. （29.01±5.73） min], QT interval was prolonged [（0.44±0.05） s vs. （0.53±0.08） s] and AF conversion success rate increased （65.15% vs. 89.39%） in observation group （all P〈O.05）. After treatment, peak E [（72.62 ± 8.92） cm/s vs. （60.52±7.32） cm/s], LVEDD [（58.34 ± 5.73） mm vs. （51.32±4.99） mm] and LVEF [（67.29±7.62）% vs. （59.56±6.15）%] increased and peak A [（55.58±6.65） cm/s vs. （68.42± 8.14） cm/s, all P〈O.05] decreased in observation group compared with control group. The levels of hs-CRP [（37.11±6.32） mg/L vs. （67.27 ± 7.51） rag/ L], IL-6 [（60.17 ± 5.45） μg/L vs. （87.58 ± 7.21） μg/L], IL-8 [（84.44 ± 5.21） IX g/L vs. （121.31± 8.57） μg/L] and NT-pro-BNP [（89.27±7.33） pg/mL vs. （142.7 ±13.29±8.57） pg/mL] were significantly lower in observation group than those in control group after treatment （all P〈0.05）. Conclusion Ibutilide has better AF conversion effect than amiodarone, and heart functionand inflammatory indexes are improved in AF patients after treatment.