心房颤动药物转复的方法探讨

Effectiveness of Propafenone and Lanatoside C in Reversing Atrial Fibrillation

目的 对比研究普罗帕酮 (静脉和顿服 )与毛花甙C转复非瓣膜病心房颤动 (房颤 )的临床疗效和安全性。方法 房颤发作在 0 5h～ 41d的患者 97例 ,临床排除心脏瓣膜病、心力衰竭 (NYHA心功能≥III级 )、心肌梗死、病态窦房结综合症、II度以上房室传导阻滞、预激综合症及甲状腺机能亢进。随机分为三组 :⑴静脉普罗帕酮组 :共 3 3例 ,普罗帕酮 70mg于 7min内静注完 ,未转复者予 14 0mg以 0 5～ 1mg/min静滴。⑵顿服普罗帕酮组 :共 3 2例 ,顿服负荷量普罗帕酮 45 0mg。⑶静脉毛花甙C组 :共 3 2例 ,毛花甙C 0 4mg于 5min静注 ,若 4h仍未转复则追加 0 2mg。所有患者均在心电监护下观察心电、血压及症状变化 ,观察房颤转复及心室率的变化 ,记录从开始静脉推注或服药到转复为窦律的时间。比较三组患者 3 0min、1、2、4及 8h的转复率和转复时间。结果 三组平均转复时间 :静脉普罗帕酮组 ( 0 8± 0 4)h ,顿服普罗帕酮组 ( 4 1± 1 8)h ,静脉毛花甙C组 ( 3 7± 2 0 )h ,静脉普罗帕酮组与另两组差异有显著性 ( P <0 0 1)。三组 8h内转复率分别为 81 8%、75 0 %、68 8% ,差异无显著性 ( P =0 474>0 0 5 )。结论 上述两药三方法转复房颤 ,以静脉普罗帕酮平均转复时间最短 。

Objective To compare the effectiveness of propafenone,(intravenous and oral) and lanatoside C in reversing atrial fibrillation (AF) and their safety in non-rheumatic patients.Methods Ninety-seven recent onset(≥0 5h～41days) AF patients were included. Subjects with valvular heart disease, heart failure (NYHA heart function≥Ⅲ degree),myocardial infarction, sick sinus syndrome, atrioventricular block(≥Ⅱ degree), preexcitation syndrome and hyperthyroidism were excluded. Three groups were subdivided according to the results:⑴ The group of intravenous propafenone(groupⅠ):thirty-three patients were given intravenous injection propafenone 70 mg within 7 minutes, the non-converted patients were given another 140 mg (0 5～1mg/min) intravenous infusion. ⑵The group of oral loading dose propafenone: Thirty-two patients were given propafenone 450 mg orally(groupⅡ).⑶The group of intravenous lanatoside C(groupⅢ):Thirty-two patients were given intravenous lanatoside C 0 4 mg within five minutes and another 0 2 mg must be added to if AF was not reversed in 4 hours. EKG, blood pressure, symptoms, AF reversing and ventricular rate were closely observed under heart monitoring all patients. The time from intravenous injection or receiving the drug to reversing the AF to sinus rhythm was recorded. Observing the reversal rate and time of the three groups of patients for 30 minutes,1h, 2h, 4h, 8h respectively, we could get the results as follows.Results Average reversal time is: group Ⅰ (0 8±0 4)h, group Ⅱ(4 1±1 8)h. group Ⅲ(3 7±2 0)h, There was a prominent difference (P<0 01) between the group of intravenous propafenone and the other two. The 8 hours reversal rates of the three groups were recorded as 81 8%, 75 0, 68 8% respectively, without a significant difference (P>0 05).Conclusion Of the above three methods in reversing AF, the average reversal time of intravenous propafenone is the shortest, and the have the most efficient reversal rate.