胺碘酮对左心室肥厚患者体外循环下主动脉开放后心室颤动发生率的影响

Effect of amiodarone on ventricular fibrillation after release of aortic cross-clamp in patients with left ventricular hypertrophy undergoing cardiopulmonary bypass surgery

目的:探讨胺碘酮对左心室肥厚患者体外循环下主动脉开放后室颤发生率的影响。方法:选择2021年1—12月在本院全麻下行心内直视手术的左室肥厚患者54例,随机分为胺碘酮组(n=27)和对照组(n=27)。主动脉开放前30 min,胺碘酮组给予胺碘酮150 mg,5 min泵完;对照组则给予等量生理盐水。结果:胺碘酮组室颤发生率低于对照组,且室颤持续时间、除颤次数和除颤能量均低于对照组(P <0.05)。胺碘酮组临时起搏使用时间长于对照组(P <0.05)。在体外循环结束后,胺碘酮组较对照组心率和平均动脉压降低、平均肺动脉压升高(P <0.05),且血管活性药剂量高于对照组(P <0.05);但在手术结束前,两组血管活性药剂量和血流动力学状态无明显差异性(P> 0.05)。结论:胺碘酮能安全用于并降低心内直视手术的左室肥厚患者主动脉开放后室颤发生率并减少室颤持续时间、除颤次数和除颤能量。

Objective:To investigate the efficacy of amiodarone on ventricular fibrillation(VF)after release of aortic cross-clamp(ACC)in patients with left ventricular hypertrophy(LVH)undergoing cardiopulmonary bypass(CPB)surgery. Methods:In this study,a total of 54 patients with LVH were enrolled to receive CPB surgery in the First Affiliated Hospital of Nanjing Medical University from January 2021 to December 2021. All patients were randomly divided into either amiodarone group(group A)or control group(group C),27 cases in each group. Thirty minutes before ACC wasreleased,the trial drugs were administered intravenously. In group A,150 mg of amiodarone was pumped in 5 minutes. In group C,the same volume of normal saline was pumped in 5 minutes. Results:The incidence of VF in group A was lower than that in group C,and the duration of VF,the number of defibrillation and the defibrillation energy were lower than those in group C(P < 0.05). The duration of temporary pacing in group A was longer than that in group C(P < 0.05). After the end of CPB,the heart rate and mean arterial pressure were lower in group A,the mean pulmonary arterial pressure and the dose of vasoactive drugs was higher than those in group C(P < 0.05). However,there was no significant difference in vasoactive drug dose and hemodynamic status between the two groups before the end of surgery(P > 0.05). Conclusion:In patients with LVH undergoing CPB surgery,amiodarone can be safely used and reduce the incidence of VF,VF duration,defibrillation frequency and defibrillation energy after ACC was released.