尼非卡兰控制心脏术后顽固性快速心房颤动的疗效及安全性研究

Efficacy and safety of intravenous nifekalant for refractory atrial fibrillation after cardiac surgery

目的研究尼非卡兰在胺碘酮复律失败的心脏术后心房颤动(房颤)中的心律转复效果及对短期预后的影响。方法回顾性分析2015年5月1日至2023年4月30日于上海交通大学医学院附属新华医院心胸外科51例心脏术后发生快速心房颤动且胺碘酮给药24 h后心律仍未得到有效转复的患者的临床数据,其中29例(CON组)在胺碘酮给药24 h后给予电复律治疗,22例(NFK组)在胺碘酮给药24 h复律失败后给予尼非卡兰负荷剂量+静脉维持。分析比较两组患者房颤转复率、不良事件发生率及短期预后差异。结果CON组患者中24例(82.8%)电复律后成功恢复窦性心律,NFK组患者中尼非卡兰静脉维持期间16例(72.7%)恢复窦性心律(P=0.388),其余6例患者在尼非卡兰用药后行电复律治疗,均恢复窦性心律,NFK组总复律成功率高于CON组(P=0.040)。NFK组与CON组相比,24小时内窦性心律维持率(100%比72.4%,P=0.007)、48 h内窦性心律维持率(95.5%比69.0%,P=0.018)、复律后左心室收缩功能[(47.3±4.32)%比(44.3±4.77)%,P=0.025]、ICU滞留时间[(7.36±4.24)d比(9.86±3.73)d,P=0.030]及主诉疼痛发生率(18.2%比75.9%,P<0.001)均占优,未发生明显心动过缓或室性心律失常,两组转氨酶及血肌酐升高发生率差异无统计学意义。结论静脉使用尼非卡兰可有效控制胺碘酮复律失败的心脏术后房颤是安全且有效的。

Objective To study the effect of intravenous nifekalant on defibrillation in patients with refractory postoperative atrial fibrillation(POAF).Methods The clinical data of 51 patients who experienced rapid POAF which was still persistent after 24 hours intravenous amiodarone in Shanghai Xinhua Hospital from May 2015 to April 2023 were retrospectively analyzed.29 cases(CON group)before Apr.2019 were given electrical defibrillation after amiodarone administration;22 cases(NFK group)were given nifekalant for 24 hours after a loading dose after amiodarone administration.The cardioversion rate within 24-hr,cardioversion time,drug-related complication rates,ICU and hospitalization time were compared between the two groups.Results The cardioversion rate of CON group was 82.8%(24/29),while it 72.7%(16/22)of NFK group(82.8%vs.72.7%,P=0.388).The other 6 cases of NFK group conversed after electric defibrillation following by the nifekalant administration.The total cardioversion rate of NFK group was significantly higher than CON group(100%vs.82.8%,P=0.040).Compared with CON group,the maintenance rate within 24-hour(100%vs.72.4%,P=0.007)and 48-hour(95.5%vs.69.0%,P=0.018)of sinus rhythm was higher in NFK group,and ICU stay time[(7.36±4.24)days vs.(9.86±3.73)days,P=0.030]was shorter with higher LVEF[(47.3±4.32)%vs.(44.3±4.77)%,P=0.025]and less complain of pain(18.2%vs.75.9%,P<0.001).There were no significant difference in the incidence of bradycardia or ventricular tachycardia and significant damage of liver and kidney function was observed in both groups.Conclusion Nifekalant for refractory atrial fibrillation after cardiac surgery is safe and effective.