伊布利特转复老年新发持续性心房颤动合并左心室功能不全患者的临床观察

Clinical observation of ibutilide for immediate cardioversion of recent-onset persistent atrial fibrillation in elderly patients with left ventricular dysfunction

目的探讨伊布利特转复老年（〉65岁）新发持续性心房颤动（PAF）合并左心室功能不全（LVD）患者的疗效和安全性。方法选取2014年1月至2017年8月在我院心内科住院的100例老年新发PAF合并LVD患者,按照随机数字表法分为两组：伊布利特组（n=50）采用伊布利特静脉注射转复,首次剂量1 mg,稀释后缓慢注射;胺碘酮组（n=50）采用胺碘酮静脉注射转复,首次剂量150 mg,稀释后缓慢注射。比较两组患者用药后30 min内、60 min内、4 h内、24 h内的转复率,检测用药前及用药后48 h左心室功能指标（LVEDD、LVESD、LVEF及NTproBNP）,并记录两组患者转复用药过程中（24 h内）的不良反应。结果伊布利特组患者用药后30 min内、60 min内、4 h内、24 h内PAF转复率均高于胺碘酮组（P〈0.01或P〈0.05）,伊布利特组患者PAF的平均转复时间短于胺碘酮组（t=-3.232,P=0.002）,伊布利特QTc平均恢复时间短于胺碘酮（t=-17.743,P=0.000）。治疗48 h后,两组患者的LVEDD、LVESD、LVEF及NT-proBNP均较治疗前明显改善（P〈0.01或P〈0.05）,而伊布利特组改善更显著（P〈0.01或P〈0.05）。伊布利特组患者短期不良反应发生率低于胺碘酮组（χ~2=4.762,P=0.029）,伊布利特组不良反应持续时间短于胺碘酮组（t=-11.622,P=0.000）。结论与胺碘酮相比,伊布利特用于转复老年新发PAF合并LVD起效快,转复率高,左心室功能改善显著,安全性好。

Aim To study the efficacy and safety of ibutilide for immediate cardioversion of recent-onset persistent atrial fibrillation（ PAF） in elderly patients（ 65 years） with left ventricular dysfunction（ LVD）. Methods 100 elderly patients of recent-onset PAF with LVD were hospitalized in our department of Cardiology from January 2014 to August 2017,and divided into two groups by random number table method： ibutilide group（ 50 cases） were treated with ibutilide intravenous injection on conversion,initial dose was 1 mg,slow injection after dilution; amiodarone group（ 50 cases）were treated with amiodarone intravenous injection on conversion,initial dose was 150 mg,slow injection after dilution.The cardioversion rates were compared between the two groups within 30 min,60 min,4 hours and 24 hours,the left ventricular function indexes（ LVEDD,LVESD,LVEF and NT-proBNP） were measured before treatment and 48 hours after treatment,and adverse events were recorded in the two groups during the conversion（ within 24 hours）. Results The cardioversion rates of PAF in the ibutilide group were higher than those in the amiodarone group within 30 min,60 min,4 hours and 24 hours（ P〈0.01 or P〈0.05）,the average cardioversion time of PAF in the ibutilide group were shorter than that in the amiodarone group（ t =-3.232,P = 0.002）. QTc average recovery time in the ibutilide group were shorter than that in the amiodarone group（ t =-17.743,P = 0.000）. LVEDD,LVESD,LVEF and NT-proBNP were significantly improved in the two groups compared with before treatment and 48 hours after treatment（ P〈0.01 or P〈0.05）,the ibutilide group improved more significantly（ P〈0. 01 or P〈0. 05）. The incidence of short-term adverse reactions in the ibutilide group was lower than that in the amiodarone group（ χ~2= 4.762,P = 0.029）,the duration of adverse events in the ibutilide group were shorter than that in the amiodarone group（ P =-11.622,P = 0.000）. Conclusion Compared with amiodarone,ibutilide was used in the treatment of recent-onset PAF in elderly patients with LVD,with rapid onset,high conversion rate,significant improvement in LVD and good safety.