可达龙院前急救治疗快速性心律失常患者的效果及安全性分析

The effect and safety of amiodaronum in the treatmentof patients with tachyarrhythmia in the process of pre-hospital care

目的探讨快速性心律失常(TH)患者院前急救应用可达龙治疗的效果及安全性。方法以2012年1月至2016年12月胶州市人民医院急救中心院前急救时现场治疗的942例快速性心律失常患者为研究对象,根据治疗方法分为对照组(471例)和观察组(471例)。其中观察组男性269例,女性202例;年龄35～81岁,平均(60.8±14.2)岁,对照组男性270例,女201例;年龄34～83岁,平均(60.9±14.4)岁,对照组采用常规方法治疗,观察组在对照组基础上在院前接受可达龙静脉输注治疗,以患者离开院内抢救室为研究终点,观察两组治疗前、后患者的心率(HR)、收缩压(SBP)、舒张压(DBP)等血流动力学指标变化、疗效及药物副反应发生情况。结果观察组治疗后HR为(75.3±4.6)次/min、SBP为(102.7±12.2)mm Hg与DBP为(73.2±5.4)mm Hg,均低于对照组的HR(111.2±4.9)次/min、SBP(114.3±13.1)mm Hg与DBP(80.4±6.4)mm Hg(P均<0.01)。观察组治疗后有效率为81.53%,高于对照组72.40%,差异有统计学意义(P<0.05)。对照组未见药物不良反应。观察组471例患者院前采用可达龙急救治疗有效373例(79.2%),无效98例(20.8%);共有22例(4.7%)发生药物副反应,主要表现为血压过低和窦性心动过缓。结论 TH患者院前急救应用可达龙的疗效与安全性均值得肯定,建议将可达龙作为快速性心律失常患者院前急救的首选药物。

Objective To investigate the effect and safety of amiodaronum in the treatment of patients with tachyarrhythmia（ TH） before hospitalization. Methods From January 2012 to December 2016,942 patients with tachyarrhythmias who were treated on-site at the emergency center of Jiaozhou People＇s Hospital Emergency Center were selected as subjects. According to the treatment methods,they were divided into control groups（ 471 cases） and observation group（ 471 cases）. The observation group consisted of 269 males and 202 females,aged 35 to 81 years,with an average age of（ 60. 8 ± 14. 2） years. The control group consisted of 270 males and 201 female,aged 34 to 83 years,with an average age of（ 60. 9 ± 14. 4）years. The control group was treated with conventional method. The observation group was treated with achievable intravenous infusion of amiodaronum before hospital on the basis of the conventional method. The patient leaving the hospital emergency room is regarded as the study endpoint and the patient＇s heart rate（ HR） before and after treatment was observed. Changes in hemodynamic parameters such as systolic blood pressure（ SBP） and diastolic blood pressure（ DBP）,efficacy,and occurrence of adverse drug reactions were obseved. Results After treatment,HR（ 75. 3 ± 4. 6）/min,SBP（ 102. 7 ± 12. 2） mm Hg and DBP（ 73. 2 ±5. 4） mm Hg were lower in the observation group than those in the control group HR（ 111. 2 ± 4. 9）/min,SBP（ 114. 3 ± 13. 1） mm Hg and DBP（ 80. 4 ± 6. 4） mm Hg,which were statistically significant（ P〈0. 01）.The effective rate in the observation group was 81. 53% after treatment and was higher than that in the control group（ 72. 40%）. The difference was statistically significant（ P〈0. 05）. There were no adverse drugreactions in the control group. In the observation group,471 patients were treated before the hospital,with373 effective cases（ 79. 2%） and 98 ineffective cases（ 20. 8%）. 22 cases（ 4. 7%） experienced adverse drug reactions,wtih low blood pressure and sinus bradycardia. Conclusions The curative effect and safety of the pre-hospital emergency treatment of TH patients in the pre-hospital emergency treatment are worthy of recognition. It is suggested that amiodaronum should be used as the first choice for the pre-hospital care of patients with Tachyarrhythmia.