胺碘酮与美托洛尔联合应用对非瓣膜病心房颤动的疗效及安全性观察

观察静脉胺碘酮与美托洛尔联合应用对非瓣膜病心房颤动 (简称房颤 )的疗效及安全性。 49例冠心病伴发房颤的患者 ,按既往是否常规服用美托洛尔或氨酰心安而分入A组 ( 2 5例 )、B组 ( 2 4例 )。全部病例先给予胺碘酮负荷量 ( 3～ 5mg/kg)静脉推注 1 0min ,然后以 60 0 μg/min的速度静滴 48h ,B组同时口服美托洛尔 6.2 5～ 2 5mg ,2次/日。行心电、血压监测 ,观察 48h房颤转复率。B组 48h后转复率为 83.3% ( 2 0 /2 4 ) ,A组为 76% ( 1 9/2 5 ) ,P >0 .0 5。A、B两组转复时间、胺碘酮用量及转复后心率比较 ,差异有显著性 ( 1 7.2± 1 0 .6hvs 9.4± 9.2h ;880 .2±395 .3mgvs5 76.4± 331 .9mg ;86.3± 1 8.2次 /分vs76.8± 1 7.9次 /分 ,P均 <0 .0 5 )。副反应发生率A组为 8.0 % ,B组为 8.3% ,P >0 .0 5。结论 :静脉胺碘酮与美托洛尔联合应用对非瓣膜病房颤安全有效 ;与单用胺碘酮相比 ,转复时间短、胺碘酮用量少。

The Efficacy and Safety of Amiodarone Combined With Metoprolol on Nonvalvular Atrial Fibrillation

To observe the efficacy and safety of amiodarone combine with metoprolol on nonvalvular atrial fibrillation (AF),49 patients with coronary artery disease accompanying AF were divided into group A (25 cases)and group B(24 cases) according to wether the routine oral metoprolol was performed before admittance.Intravenous loading dose of 3～5 mg/kg of amiodarone was given within 10 min,followed by 600 μg/min infusion for 48 hours in group A and group B,and group B was combined with oral metoprolol of 12.5～50 mg/d.Result:83.3%(20/24) patients with AF restored to normal sinus rhythm in group B and 76%(19/25) sinus rhythm was obtained in group A.There was no significant difference in restoration rates during 48 hours between group A and group B,but dose of amiodarone was lower,restoration duration was shorter,the rhythm after restoration was slower in group A than group B(576.4±331.9 mg vs 880.2±395.3 mg ,9.4±9.2 h vs 17.2±10.6 h,76.8±17.9 bpm vs 86.3±18.2 bpm,respectively,all P < 0.05).The side effect for group A and group B were 8.0% and 8.3% respectively.Concusion:Amiodarone combined with metoprolol is effective and safe for treatment of nonvalvular AF and shows a shorter restoration duration and a lower dose of amiodarone.