影响伊布利特转复心房颤动成功率的相关因素分析

Related factors affecting success rate of ibutilide for atrial fibrillation cardioversion

目的探讨多个因素对应用伊布利特转复非瓣膜性心房颤动(房颤)患者成功率的影响。方法回顾分析自2012年9月至2021年6月于泰安市中心医院心内科住院的130例应用伊布利特进行转复治疗的阵发性或持续性非瓣膜性房颤患者的临床资料。根据注射伊布利特后是否成功将房颤转复为窦性心律,分为复律成功组和复律不成功组。分析两组患者的多个因素,包括性别、年龄、血压、血糖、胆固醇、低密度脂蛋白(LDL)、N末端脑钠肽前体(NT-proBNP)、钠离子(Na^(+))浓度、钾离子(K^(+))浓度、超敏C反应蛋白(hs-CRP)、有无合并基础心血管疾病、有无甲状腺功能亢进、肝功异常、肾功异常,有无贫血、房颤分型(阵发性房颤、持续性房颤)等因素对转复成功率的影响。结果应用伊布利特转复的房颤患者共130例,其中成功转复为窦性心律者90例,不成功40例,转复成功率为69.23%;平均转复时间为34.60 min;复律成功组和不成功组患者的年龄、血压(收缩压、舒张压)、血糖、LDL、Na^(+)、K^(+)、hs-CRP、患者是否合并基础心血管疾病、有无甲状腺功能亢进、肝功能异常、肾功能异常、有无贫血等比较差异无统计学意义(P>0.05);两组间的性别、NT-proBNP、胆固醇水平、房颤分型比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析显示:女性(OR=3.536,95%CI:1.163~10.756)、阵发性房颤(OR=17.121,95%CI:6.137~47.761)、NT-proBNP(OR=1.000,95%CI:0.999~1.000)是影响伊布利特成功转复房颤的独立影响因素。结论应用伊布利特转复房颤的有效率为69.23%,平均转复时间为34.60 min;女性、阵发性房颤、NT-proBNP等因素对伊布利特转复房颤成功率的独立预测因素。

Objective To discuss the influence of multiple factors on success rate of ibutilide for cardioversion in patients with atrial fibrillation(AF).Methods The clinical materials of patients(n=130)with paroxysmal or persistent non-valvular atrial fibrillation(NVAF)treated with ibutilide for cardioversion were retrospectively analyzed in Department of Cardiology in Central Hospital of Tai`an City from Sept.2012 to June 2021.According to whether AF was successfully converted to sinus rhythm after ibutilide injection or not,the patients were divided into successful group and unsuccessful group.The influence of multiple factors on success rate of cardioversion were analyzed in 2 groups,including gender,age,blood pressure,blood sugar,cholesterol,low-density lipoprotein-cholesterol(LDL),N-terminal pro-brain natriuretic peptide(NT-proBNP),concentration of sodium ion(Na^(+))and potassium ion(K^(+)),high sensitivity C-reactive protein(hs-CRP),basic cardiovascular diseases,hyperthyroidism,abnormal liver function and kidney function,anemia,and types of AF[paroxysmal atrial fibrillation(PAF),persistent atrial fibrillation(PeAF)].Results Among 130 AF patients treated with ibutilide for cardioversion,AF was successfully converted to sinus rhythm in 90 cases and was not successful in 40 cases.The successful rate was 69.23%and average cardioversion time was 34.60 min.The differences in age,blood pressure(systolic blood pressure,diastolic blood pressure),blood sugar,LDL,concentration of Na^(+)and K^(+),hs-CRP,basic cardiovascular diseases,hyperthyroidism,abnormal liver function and kidney function and anemia had no statistical significance between 2 groups(P>0.05).The differences in gender,NT-proBNP,cholesterol and AF types had statistical significance between 2 groups(P<0.05).The results of multi-factor Logistic regression analysis showed that female(OR=3.536,95%CI:1.163~10.756),PAF(OR=17.121,95%CI:6.137~47.761)and NT-proBNP(OR=1.000,95%CI:0.999~1.000)were independent factors affecting successful cardioversion of ibutilide for AF.Conclusion The successful rate of cardioversion with ibutilide was 69.23%and average cardioversion time was 34.60 min.Female,PAF and NTproBNP are independent predictive factors for success rate of cardioversion with ibutilide.