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目的比较静脉应用不同剂量胺碘酮,治疗充血性心力衰竭伴快速心房颤动患者心室率的有效性及安全性。方法选取45例快速房颤患者[心室率>120bpm(次/min),心功能NYHA分级≥Ⅱ级],随机分成3个不同剂量组,每组15人。第1、2、3组每次静脉给予的负荷剂量分别为75mg、150mg和250mg,首次给予胺碘酮(生理盐水稀释成20ml)缓慢静脉注射10min,如不转复为窦性心律,以相同的剂量每30min重复一次达4次。结果三组控制房颤伴快速心室率的总有效率分别为67%、78%、91%(P>0.05)。三组心室率在用药30min后平均下降幅度分别为(6.84±7.30)bpm、(16.10±9.89)bpm、(20.37±14.55)bpm,第1组与第2、3组比较差异有统计学意义(P<0.01),用药1h后平均下降幅度分别为(14.91±11.39)bpm、(20.51±13.66)bpm、(32.36±13.59)bpm(P<0.01),用药2h后平均下降幅度分别为(31.21±22.73)bpm、(29.82±14.34)bpm、(36.95±18.29)bpm(P>0.05)。各组用药后Q-T间期、血压差异无统计学意义(P>0.05)。患者均无严重心律失常发生,未诱发或加重心功能不全。结论静脉应用不同剂量胺碘酮均能快速、安全、有效控制充血性心力衰竭并发快速心房颤动患者心室率,并能使部分患者转复。较大剂量组能够更快控制房颤患者心室率,但不良反应发生率提高。
Objective To compare the effectiveness and safety of different doses of intravenous amiodarone in the treatment of ventricular rate in patients with congestive heart failure and rapid atrial fibrillation. Methods Forty-five patients with fast AF (ventricular rate> 120 bpm and NYHA class ≥ 2) were randomly divided into 3 different dose groups (15 in each group). Group 1, 2, 3 intravenous doses of 75mg, 150mg and 250mg respectively, for the first time amiodarone (diluted to 20ml normal saline) intravenous injection of 10min, if not converted to sinus rhythm, the same The dose is repeated every 30 minutes up to 4 times. Results The total effective rates of three groups in controlling atrial fibrillation with rapid ventricular rate were 67%, 78% and 91%, respectively (P> 0.05). The ventricular rate of the three groups decreased by (6.84 ± 7.30) bpm, (16.10 ± 9.89) bpm and (20.37 ± 14.55) bpm respectively after 30 minutes of treatment. The difference between the first group and the second and third groups was statistically significant ( (P <0.01). The mean decrease amplitude after 1 h of treatment was (14.91 ± 11.39) bpm, (20.51 ± 13.66) bpm and (32.36 ± 13.59) bpm respectively 22.73) bpm, (29.82 ± 14.34) bpm, (36.95 ± 18.29) bpm (P> 0.05). There was no significant difference in Q-T interval and blood pressure between the two groups (P> 0.05). No serious arrhythmia patients, did not induce or aggravate heart failure. Conclusion Intravenous administration of different doses of amiodarone can rapidly, safely and effectively control the ventricular rate in patients with congestive heart failure complicated with rapid atrial fibrillation, and can make some patients return. The larger dose group was able to control the ventricular rate faster in patients with atrial fibrillation, but the incidence of adverse reactions increased.