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目的观察静脉滴注胺碘酮治疗急性冠脉综合征(ACS)伴快速房颤(Af)患者的临床疗效。方法选择68例ACS患者,男46例,女22例,年龄32~87岁。不稳定型心绞痛40例,急性心肌梗死28例。房颤距ACS发病时间0.5~168 h,平均心室率(139±21)次/min,房颤发作时胺碘酮150 mg缓慢静脉注射后,以0.25~1.5 mg/min持续静脉滴注,直至转复为窦性心律,用药开始24 h内不合用洋地黄片、β受体阻滞剂、钙拮抗剂,同时持续心电、血压监测,如收缩压<90 mm Hg,予以多巴胺合用。统计计量资料用均数±标准差(x-±s)表示,比较用t检验,治疗前后采用配对t检验,使用SPSS12统计软件统计分析,P<0.05为差异有统计学意义。结果①Af转复情况:有50例(73.5%)转复为窦性心律,转复后平均心室率(74±21)次/min(51~108次/min),转复距用药前时间平均(16±13)h。22例复发(32.6%),其中18例加大胺碘酮剂量后即转复窦性心律,另外4例长R-R间期而停药。②所有患者用药15~20 min心室率下降,在2 h时、24 h明显下降,且随时间延长,心室率有逐渐下降趋势,与治疗前比较差异有统计学意义(P<0.01);2 h与24 h相比,差异也有统计学意义(P<0.01)。血压前后变化不明显。③心功能与复律:心功能,Ⅰ、Ⅱ级复率(39/44)88.4%,Ⅲ、Ⅳ级复率(6/24)25.0%,χ2=5.034,P<0.05。说明房颤转复率与心功能有关。④不良反应:4例患者分别于用药后1、3、4、105 h出现长R-R间期,最长3.2 s,停药后6~34 h均消失,1例出现皮肤瘙痒、无皮疹、经对症治疗缓解。用药2周后甲状腺功能五项均在正常范围。结论静脉应用胺碘酮治疗ACS伴快速Af有效安全。
Objective To observe the clinical efficacy of intravenous amiodarone in the treatment of acute coronary syndrome (ACS) patients with rapid atrial fibrillation (Af). Methods 68 patients with ACS were selected, 46 males and 22 females, aged 32 to 87 years old. 40 cases of unstable angina pectoris, 28 cases of acute myocardial infarction. The onset of atrial fibrillation (ACS) was 0.5 to 168 h and the mean ventricular rate was (139 ± 21) times / min. After amiodarone 150 mg intravenous injection, atrial fibrillation was continued with intravenous infusion of 0.25-1.5 mg / min until Converted to sinus rhythm, do not use digitalis, beta blockers, calcium antagonists within 24 h after the start of medication, while continuing ECG, blood pressure monitoring, such as systolic blood pressure <90 mm Hg, to be combined with dopamine. Statistical measurement data were expressed as mean ± standard deviation (x- ± s), compared with t test, before and after treatment using paired t test, using SPSS12 statistical software statistical analysis, P <0.05 for the difference was statistically significant. Results ①Flap conversion was found in 50 cases (73.5%) with sinus rhythm and mean heart rate (74 ± 21) / min (51-108 beats / min) (16 ± 13) h. Twenty-two patients relapsed (32.6%). Among them, 18 patients underwent sinus rhythm after amiodarone dose was increased, and another 4 patients with long R-R interval were discontinued. (2) The ventricular rate decreased from 15 to 20 minutes in all patients and decreased significantly at 24 hours after 2 hours. With the prolongation of time, the ventricular rate decreased gradually, which was significantly different from that before treatment (P <0.01); 2 h compared with 24 h, the difference was also statistically significant (P <0.01). No significant change before and after blood pressure. Cardiac function and cardioversion: heart function, grade Ⅰ, Ⅱ (39/44) 88.4%, grade Ⅲ, Ⅳ (6/24) 25.0%, χ2 = 5.034, P <0.05. Shows that the rate of atrial fibrillation and cardiac function. ④ Adverse reactions: Four patients showed long RR interval at 1, 3, 4 and 105 h respectively, up to 3.2 s, and disappeared 6 ~ 34 h after stopping drug. One case had pruritus and no rash, Symptomatic treatment to ease. Five weeks after the administration of thyroid function are in the normal range. Conclusions Intravenous amiodarone in the treatment of ACS with rapid Af is effective and safe.