胺碘酮治疗不稳定型心绞痛并发阵发性心房颤动疗效分析

1、胺碘酮治疗不稳定型心绞痛并发阵发性心房颤动疗效分析    【关键词】  胺碘酮；不稳定型心绞痛；心房颤摘要：目的：观察胺碘酮治疗不稳定型心绞痛并发心房颤动的疗效及安全性。方法：42例不稳定型心绞痛并发心房颤动患者，随机分为胺碘酮治疗组（21例）和毛花甙C对照组（21例）。治疗组静脉注射胺碘酮150mg，未转复为窦性心律者，重复给予75150mg，后改为静脉滴注150450mg；对照组静脉注射毛花甙C0.40.8mg。结果：治疗组用药后转复为窦性心律16例（76.2%），3h内转复者7例，38h转复者9例，平均复律时间为6.2h，治疗有效率90.

2、5%；毛花甙C组用药后转复为窦性心律9例（42.9%），3h内转复者3例，38h转复者6例，平均复律时间为5.5h。治疗有效率为76.2%。两组用药后心室率均比用药前明显下降，胺碘酮组平均起效时间为（15±8）min，毛花甙C组平均起效时间为（30±5）min，两组平均起效时间及心率下降幅度差异无统计学意义。两组治疗前后QT间期及不良反应差异无统计学意义。讨论:静脉注射胺碘酮控制不稳定型心绞痛并发心房颤动的作用迅速、安全，其疗效高于毛花甙C。可作为不稳定型心绞痛并发心房颤动的首选药物之一。关键词：胺碘酮；不稳定型心绞痛；心房颤动Analyzing the Effect of

3、 Amiondarone on Unstable Angina Pectoris Complicated with Atrial FibrillationAbstract： Objective:To observe effectiveness and security of amiondarone in treating unstable angina pectoris complication by atrial fibrillation. Method: 42 patients with unstable angina pectoris complication by atrial fib

4、rillation, were compared in a randomized study.21 patients treated with amiodarone (group A) or lanatoside C (group B).Group A was treated with amiodarone intravenously as 150mg period, and followed by 75mg to 150mg if conversion to sinus rhythm failed, and followed by a 150mg to 450mg infusion. Gro

5、up B was treated with lanatoside C intravenously as 0.4mg or 0.8mg. Result: There were 16 patients in group A conversion to sinus rhythm, 7 patients were conversion in 3 hours, and 9 patients in 8 hours, the onset of action was 6.2 hours, ratio effective was 90.5%. There were 9 patients in group B c

6、onversion to sinus rhythm, 3 patients were conversion in 3 hours, and 6 patients in 8 hours, the onset of action was 5.5 hours, ratio effective was 76.2%.The ventricular ratios were significant descending in both groups.The mean onset of action group A was 15±8 minutes, and group B was 30±

7、5 minutes.The onset action and the descending range differences were no significant between two groups. The QT interval and the side effect differences were no significant between before and after treatment in both groups. Conclusion:Intravenous amiondarone controlling unstable angina pectoris compl

8、ication by atrial fibrillation effective and safe, is better than lanatoside C.Amiondarone can be used as first line drug treating unstable angina pectoris complication by atrial fibrillation.Key words:Amiondarone;Unstable angina pectoris;Atrial fibrillation不稳定型心绞痛（UA）是冠心病的防治重点，其致残率及死亡率均较高，一旦并发严重的心律

9、失常，对病人的危害极大。其中心房颤动在UA病人中发生率较高，对其进行防治，甚为重要。本报道旨在探讨静脉胺碘酮对UA并发心房颤动的复律疗效，并评价其减慢心室率的作用及安全性。1对象与方法1.1对象：选择2000年7月至2004年11月我院住院及急诊观察收治的不稳定型心绞痛并发心房颤动病例42例，所有病例均符合中华医学会心血管病分会2000年12月颁布的UA诊断标准1，并在心绞痛发作时经心电图检查证实并发心房颤动，所有病例均在应用抗凝（低分子肝素）及服用钙拮抗剂和-受体阻滞剂后，心房颤动未能得以控制。其中男27例，女15例，年龄4578（60.2±9.5）岁。房颤持续时间172h。冠心病

10、28例，冠心病合并高血压病14例，冠心病合并糖尿病5例。排除合并病态窦房结综合征、房室传导阻滞、低血压、心源性休克、电解质紊乱、两周内使用过抗心律失常药及洋地黄类药物的患者和怀孕及哺乳期妇女。入选者随机分为胺碘酮（商品名：可达龙）治疗组21例和毛花甙C对照组21例。两组在年龄、性别、体重、心室率、房颤持续时间等方面差异无统计学意义，具有可比性。1.2方法：胺碘酮治疗组予胺碘酮150mg溶于生理盐水20ml中，于10min内缓慢静脉注入，首剂后1520min未转复为窦性心律者，视情况重复给予75150mg，继之以0.51.0mg/min持续静脉点滴24h(24h总量1200mg)，复律成功即停止；毛花甙C组则予毛花甙C0.4mg溶于生理盐水20ml中,5min内静脉推注,未复律者，2h后追加0.2mg，仍未复律者，6h后再追加0.2mg。1.3观察指标：用药前后进行持续心电监护和血压监测,每5min记录心率、心律、血压和临床症状。用药前及用药后每1h、复律成功时或终止试验时记录心电图，观察ST-T变化及测量QT间期，共连续观察8h。复律成功者继续观察1h。对于心室率60次/min，血压低于90/60mmHg