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目的:了解瓣膜置换术后对伴有持久性心房颤动(Af)的门诊患者进行药物复律的安全性及有效性。方法:瓣膜置换术后伴有持久性Af且无三尖瓣中度以上反流及明显肝肾功能异常的患者78例,治疗组38例,对照组40例。治疗组口服小剂量胺碘酮、卡托普利、维生素C、辛伐他汀联合复律治疗,每个月门诊随访1次。治疗6个月后进行心脏超声心动图及心电图检查,对照组患者根据情况采用地高辛或(和)美托洛尔控制心室率。结果:治疗组患者连续2~6(5.4±3.2)个月门诊药物复律治疗,14例恢复窦性心律,转复成功率36.84%(14/38)。对照组患者中无一例恢复窦性心律,2组差异有统计学意义(P<0.05)。治疗组患者中复律成功的患者与未成功的患者在年龄、术前Af持续时间、手术前后左房径改变(△LAD1)等方面的差异有统计学意义(P<0.05)。多元回归分析显示:瓣膜置换术后门诊患者持久性Af复律的有效性主要与患者年龄、Af持续时间、手术前后△LAD1有关。结论:瓣膜置换术后持久性Af患者的门诊药物复律是安全的,其有效性主要与患者年龄、Af持续时间、手术前后△LAD1有关。
Objective: To understand the safety and efficacy of drug cardioversion in outpatients with persistent atrial fibrillation (AF) after valve replacement. Methods: There were 78 patients with persistent Af and no abnormal tricuspid regurgitation and obvious liver and kidney dysfunction after valvular replacement. There were 38 cases in the treatment group and 40 cases in the control group. The treatment group oral low dose amiodarone, captopril, vitamin C, simvastatin combined cardioversion treatment, follow-up visits once a month. Cardiac echocardiography and electrocardiogram were performed 6 months after treatment. Patients in the control group were given digoxin or (and) metoprolol to control ventricular rate. Results: The patients in the treatment group were treated with outpatient cardioversion for 2-6 months (5.4 ± 3.2) months, and the sinus rhythm was restored in 14 cases. The success rate of conversion was 36.84% (14/38). No sinus rhythm was restored in the control group, the difference between the two groups was statistically significant (P <0.05). There were significant differences in age, duration of preoperative Af, change of left atrium before and after surgery (△ LAD1) among patients with successful cardioversion and those with unsuccessful patients in the treatment group (P <0.05). Multivariate regression analysis showed that the effectiveness of persistent Af cardioversion in outpatients after valve replacement was mainly related to patient’s age, duration of Af and △ LAD1 before and after operation. Conclusions: Out-patient drug cardioversion in patients with persistent Af after valvular replacement is safe and its efficacy is mainly related to patient’s age, duration of Af, and △ LAD1 before and after surgery.