电复律治疗心脏外科术后心律失常疗效观察

Electrical Cardioversion for Treatment of Arrhythmia after Cardiac Surgery

目的:探讨直流电复律治疗心脏外科术后心律失常的疗效和安全性。方法:选取自2014年1月至2018年3月期间我院心脏术后出现快速性房性心律失常,并经负荷剂量胺碘酮应用未转复的患者共144例,根据治疗方法的不同分为对照组和观察组,对照组继续胺碘酮治疗,观察组采用同步直流电复律治疗。比较两组患者的疗效、并发症、死亡率及复发率等,同时分析观察组不同时间段静脉血中心肌损伤标志物水平。结果:观察组73例患者中总有效率84.9%,而对照组71例患者中总有效率60.6%,观察组优于对照组(P<0.05);而并发症发生率,对照组11.3%较观察组15.1%(P>0.05),死亡率相比差异无统计学意义(5.6%对0)(P>0.05)。在对观察组患者复律前及复律后24、48、72 h和1周时间检测的心肌损伤标志物水平进行统计分析结果显示,电复律后心肌损伤标志物在不同时间段出现明显升高,并随时间发展逐渐恢复至复律前水平。随访半年对照组复发率35%,高于观察组复发率16%(P<0.05)。结论:同步治疗电复律可以明显提高胺碘酮在治疗心脏外科术后快速型房性心律失常的疗效,虽然可造成心肌一过性损伤,但并不增加并发症发生率和死亡率,是一种安全有效的治疗手段。

Objective:To investigate the curative effect and safety of direct current cardioversion in the treatment of arrhythmia after cardiac surgery.Methods:From January 2014 to March 2018,144 patients with rapid atrial cardiac arrhythmia which is no response to loading dose of amiodarone after cardiac surgery were selected.According to the different treatment methods,the patients were divided into control group and observation group.The control group continued with amiodarone treatment,and the observation group was treated with direct current cardioversion.Curative effect,complications,mortality and recurrence rate were compared between the two groups of patients.The level of myocardial damage markers in the venous blood was detected at different times.Results:For the 73 patients of the observation group,the effective rate was 84.9%,which was significantly better than the control groups′s 60.6%(P<0.05).The incidence of complications was 11.3%in the control group,while 15.1%in the observation group,and the mortality was 5.6%vs 0.There was no statistical significance(P>0.05).The level of myocardial damage markers detected before cardioversion and 24,48,72 h and 1 week after cardioversion in the observation group were statistically analyzed which showed the level of myocardial damage markers increased in different times after cardioversion,and returned to the level before cardioversion with the development of time.Follow-up for half a year,the recurrence rate was 35%in the control group,which was higher than that in the observation group(P<0.05).Conclusion:Synchronized direct current cardioversion can significantly improve the curative effect of amiodarone in the treatment of rapid atrial cardiac arrhythmia after cardiac surgery.Although it can cause transient myocardial damage,it does not increase the incidence of complications and mortality.It is a safe and effective treatment.