心脏外科术后合并心房颤动治疗的临床研究

Clinical research of the treatment of atrial fibrillation after cardiac surgery

目的:研究心脏外科术后心房颤动(房颤)的治疗及预后。方法:入组的412例心脏外科术后患者转入心脏ICU,持续呼吸机辅助通气治疗中,随机分为丙泊酚镇静组(Prop组)206例及右美托咪定组(Dexm组)206例,比较两组术后房颤发生率、转复窦性心律(转律)成功率、胺碘酮累计剂量及血管活性药物用量等指标。撤离呼吸机后,Prop组窦性心律患者57例再次出现房颤,随机分为右美托咪定镇静组(Dexm-1组)及对照组,比较其房颤发生率、转律成功率、胺碘酮累计剂量及血管活性药物剂量等指标。所有8h内未成功转律的患者,分析其预后。结果:心脏外科术后8h内,与Prop组相比,Dexm组房颤发生率明显降低,胺碘酮累计剂量明显减少。心脏外科手术8h后,Dexm-1组较对照组房颤转律成功率明显提高,胺碘酮累计剂量明显减少(P<0.05),但Dexm-1组应用血管活性药物去甲肾上腺素剂量明显增加。对于8h内未成功转律患者,ICU滞留时间及术后心力衰竭发生率、全因死亡率均明显高于未发生房颤组。结论:应用右美托咪定可有效减少心脏外科术后房颤的发生,联合应用胺碘酮可提高转律成功率,减少胺碘酮转律的累计剂量。

Objective：To research the treatment and prognosis of atrial fibrillation after cardiac surgery.Method：In CICU,412 cases with cardiac surgery were randomly divided into propofol sedation group（Prop group,n=206）and dexmedetomidine sedation group（Dexm group,n=206）,all of patients needed continuous mechanical ventilation therapy,and compared the incidence of postoperative atrial fibrillation,the success rate of cardioversion,the cumulative dose of amiodarone and the dosage of vasoactive drugs.After withdrawal of ventilation,57 cases suffered from atrial fibrillation again in patients with sinus rhythm in Prop group,all of those patients were randomly divided into dexmedetomidine-1 group（Dexm-1 group）and control group,the incidence of atrial fibrillation,the success rate of cardioversion,the cumulative dose of amiodarone and the dosage of vasoactive drugs were compared.The prognosis of patients that cardioversion was not successful within 8 hours was analyzed.Result：Within 8 hours after cardiac surgery,compared with Prop group,the incidence of atrial fibrillation was significantly lower and the cumulative dose of amiodarone was significantly reduced in Dexm group.8 hours after cardiac surgery,compared with control group,the success rate of atrial fibrillation cardioversion significantly increased and the cumulative dose of amiodarone significantly reduced in Dexm-1 group,but the dose of norepinephrine increased significantly in Dexm-1 group.The ICU retention time,the rate of postoperative heart failure and the all cause mortality were higher in patients with unsuccessful cardioversion than those without atrial fibrillation.Conclusion：Dexmedetomidine can effectively reduce the occurrence of atrial fibrillation after cardiac surgery,and the combined use of amiodarone can improve the success rate of cardioversion and reduce the cumulative dose of amiodarone.