地尔硫(艹卓)与西地兰控制心房颤动心室率的对比研究

比较洋地黄和地尔硫革对心房颤动（房颤）心室率控制的疗效，报告如下。     

静脉应用地尔硫(艹卓)控制心房颤动快速心室率的临床观察

控制心房颤动快速心室率是急诊十分常见的病症,临床一般应用毛花甙C(西地兰),由于西地兰起效慢,不易达到理想的心室率,且当交感神经兴奋时,西地兰疗效不佳.     

静脉注射地尔硫(艹)(卓)注射液治疗难治性不稳定型心绞痛的疗效观察

对于经冠状动脉造影显示具有两支以上经冠状动脉弥漫性病变,经硝酸酯类药物治疗无效,又不具备经皮冠状动脉内支架安置术(PCI)和冠状动脉旁路移植术(CABG)条件的冠心病患者,我们给予静脉注射地尔硫(艹)/(卓)注射液治疗获得了很好的疗效,现报道如下.     

地尔硫(艹卓)、美托洛尔、地高辛控制快速房颤心室率的安全性及疗效评价

目的:观察地尔硫革、美托洛尔、地高辛控制快速房颤心室率的有效性及安全性.方法:选择快速房颤心室率患者(HR＞100次/min)95例采用随机方式分为地尔硫革组(32例),90～240 mg/d,分3次口服;美托洛尔组(32例),12.5～50 mg/d,分2次口服;地高辛组(31例),0.125～0.25 mg/d,1次口服.观察其有效率(心室率下降≥20%)及症状体征变化.结果:地尔硫革、美托洛尔及地高辛控制房颤的快速心率总有效率分别为91%、92%、71%,心室率分别下降为(84.2±21.2)次/min、(83.7±18.9)次/min、(95.3±19.3)次/min,平均起效时间分别为(23.5±5.2)h、(24.5±3.8)h、(45.1±7.5)h,3组复律分别3例、3例、1例,地尔硫革组出现低血压3例,窦性心动过缓1例;美托洛尔组出现低血压4例,窦性心动过缓1例;地高辛组出现窦性心动过缓1例,均自行缓解,未发生心衰加重.结论:与地高辛相比,口服地尔硫革、美托洛尔能有效控制其静息及活动后心室率,起效迅速,且均无明显副反应.     

盐酸地尔硫（艹/卓）控制快速心房颤动心室率的疗效观察

目的观察盐酸地尔硫控制快速心房颤动心室率的效果。方法突发快速心房颤动持续 6小时以内的患者 80例 ,随机分为盐酸地尔硫组 (H组 ,n =40例 )和西地兰组 (C组 ,n =40例 ) ,H组立即静注盐酸地尔硫注射液 1 0mg ,并 30mg +5 %葡萄糖注射液2 50ml静脉滴注 ,C组立即静注西地兰 0 .4mg ,4小时以后再注射 0 .4mg ,用药开始后每 30分钟记录心电图及血压 ,共 8小时。 结果H组用药后 60分钟心室率明显下降 (与用药前相比P <0 .0 5) ;H组用药 4小时后 95 %的患者心室率降到 90次 /min以下 ,而C组只有 40 %的心室率达到这一水平 (P <0 .0 0 1 ) ,两组心房颤动转复率相仿 ,均无严重不良反应。结论盐酸地尔硫较西地兰能更迅速有效、安全地控制快速心房颤动的心室率。     

地尔硫(艹)/(卓)在治疗心血管疾病中的应用

地尔硫(艹)/(卓)是一种苯噻氮(艹)/(卓)类钙拮抗剂[1]. 能扩张冠状动脉,防止和缓解冠状动脉痉挛,增加冠状动脉血流,改善心内膜下心肌灌注,降低血压和心率以减少心肌耗氧量,并可防止心肌细胞内钙超负荷,减少氧自由基生成及降低血小板聚集功能[2].     

贝那普利联合地尔硫(艹卓)治疗伴左房扩大的阵发性心房颤动

临床上,阵发性心房颤动（房颤）随时间的推移,常演变为持久房颤,多数伴随左房的逐渐扩大。目前认为房颤时心房肌的电重构和随之产生的心房肌的纤维化是产生这一现象的主要原因,而血管紧张素Ⅱ介导的心房肌细胞内钙负荷过重可能是这一过程中的中心环节。我们采用贝那普利和地尔硫莲长期治疗阵发性心房颤动,取得较好效果。现将结果报道如下。     

地尔硫(艹卓)革治疗缺血性心肌病患者心绞痛疗效观察

目的探讨口服地尔硫治疗缺血性心肌病(ICM)患者心绞痛(ICM-AP)的临床疗效。方法72例ICM-AP患者随机分为两组,对照组30例给予常规抗心绞痛、纠正心衰治疗,地尔硫组42例在以上常规治疗基础上给予地尔硫15~30 mg,每日4次,分别于9:00、15:00、21:00、3:00时间点口服,疗程2周。对比观察两组心绞痛改善程度和心电图变化,以及药物对心率、血压和心功能的影响。结果地尔硫组治疗心绞痛的临床总有效率高于对照组(P<0.05),两组心功能改善等级比较差异无统计学意义(P>0.05),两组血压比较差异无统计学意义(P>0.05),地尔硫组心率低于对照组(P<0.05)。结论口服地尔硫治疗ICM-AP安全有效。     

静脉注射普罗帕酮和地尔硫(艹)/(卓)转复阵发性心房颤动的疗效比较

目的　对比研究普罗帕酮和地尔硫 艹卓 转复阵发性心房颤动 (房颤 )的作用。方法　 62例房颤持续时间 <48h的患者随机分入普罗帕酮组 (n =32 )和地尔硫艹卓 组 (n =30 ) ,分别静脉注射普罗帕酮 70mg、地尔硫艹卓1 0mg。 1h后普罗帕酮组和地尔硫 艹卓 组未转复者交叉用药。结果　首次给药后普罗帕酮组的转复率为 65 7% ,地尔硫 艹卓 组的转复率为 33 3 % (P <0 0 1 )。交叉给药后 ,普罗帕酮的转复率为 68 4% ,而地尔硫 艹卓 的转复率为 30 % (P <0 0 1 )。转复成功者的左房内径明显小于转复失败者 (41 1± 5 2 )mmvs(47 7± 6 9)mm ,P <0 0 0 1。当左房内径≤ 40mm ,普罗帕酮和地尔硫 艹卓 的转复率均较高且无显著差异(75 %vs 66 7% ,P >0 0 5)。当左房内径 >50mm ,普罗帕酮和地尔硫艹卓 的转复率均较低且存在统计学差异 (40 %vs 1 1 1 % ,P <0 0 1 )。结论　静脉注射普罗帕酮较地尔硫艹卓 能更有效转复房颤心律。左房内径是影响房颤转复的独立预测因素。     

静脉应用地尔硫(艹卓)治疗心房纤颤伴快速心室率疗效观察

目的　观察静脉应用地尔硫艹卓对减慢心房纤颤伴快速心室率患者心室率的疗效及其安全性。方法　４０ 例心房纤颤伴快速心室率者被随机分为地尔硫艹卓治疗组和毛花甙丙治疗组,观察用药后心室率和血压变化。结果　毛花甙丙组有效率为７５ ％ ,地尔硫艹卓组为９５ ％ , Ｐ＜ ００１ 。毛花甙丙组最大效应时间为９６０ ±２８０ 分钟,地尔硫艹卓组为８０ ±２５ 分钟。地尔硫艹卓组有５ 例病人出现一过性无症状性低血压,无需处理。结论　地尔硫艹卓对降低心房纤颤伴快速心室率患者的心室率具有疗效高、起效迅速、安全等优点。     

快速型心房颤动患者静脉应用地尔硫卓和美托洛尔的疗效观察

目的 比较静脉注射地尔硫卓和美托洛尔控制心房颤动(简称房颤)患者快速心窒率的疗效.方法吉林人学第二医院2003年1月至2006年7月收治的48例心室率>120次/min 且收缩压≥100 mmHg的房颤患者分为地尔硫卓组(n=24)和美托洛尔组(n=24).地尔硫卓和美托洛尔的用法分别为10 nag和5 mg静脉注射.记录用药后5 min,10 min,15 min和30 min时的患者的心率和血压.治疗有效的定义为用药30 min后心室率下降至100次/min以下或较用药前的心率下降20%以上或转复为窦性心律.数据比较采用t检验、配对t检验及χ2检验.结果 和用药前比较,两种药物在上述各个时间点均能显著降低房颤时的快速心窒率(P<0.01),但除用药后30 min外,其它各时间点地尔硫卓组的心窒率显著低于美托洛尔组(P<0.05).在降低心室率的同时,这两种药物亦使血压有所降低,但两组之间的降压作用差异无统计学意义.两组均未见药物所敛的低血压者.用药后30min,地尔硫卓组和美托洛尔组的治疗有效率分别为91.7%和83.3%(P>0.05).结论 静脉注射地尔硫卓10 mg或荚托洛尔5 mg在30 min均能使房颤时的快速心室率显著降低,无以地而硫卓作用更强.     

硫酸镁在快速房颤患者中的治疗作用

目的观察常规西地兰治疗外加用硫酸镁治疗房颤伴快速心室率患者的作用和安全性。方法229例急诊就诊的房颤伴快速心室率患者被随机分为两组,硫酸镁组除常规西地兰治疗外,给予硫酸镁2.5g20min内静脉注射,继之2.5g2h内静脉输液;对照组除常规西地兰治疗外加用安慰剂治疗。结果给药2h内硫酸镁组心室率降至100次/min以下者、转复为窦性心律者均显著多于安慰剂组(P<0.001或P<0.05),而两组不良反应发生率比较差异无统计学意义(P>0.05)。结论对房颤伴快速心室率患者在常规西地兰治疗外加用硫酸镁治疗可起到辅助和加强治疗效果的有益作用,并且比较安全。     

116例慢性心房颤动患者心室率增快的诱因调查

目的：探讨慢性房颤患者急性心室率增快的诱因,为临床及时干预、治疗提供指导。方法：回顾性分析急诊收治的116例慢性房颤急性心室增快的临床资料。结果：116例患者中,肺部感染诱发慢性房颤急性心室率增快居首位,占52．59％,其他为急性胃肠炎,情绪改变、疼痛、疲劳与劳累,尿潴留等。结论：慢性房颤急性心室率增快均有相关诱因参与触发,关注并及时干预,去除诱因,对控制心室率具有重要意义。其中14例患者去除诱因后,达到了心室率减慢的治疗效果,占12．07％。     

Electrophysiological control of ventricular rate during atrial fibrillation

Thirteen anesthetized canine subjects (17-29 kg) were used to demonstrate that mild cervical left vagal stimulation could control ventricular rate effectively during atrial fibrillation (AF). Two studies are presented. The first study used six subjects to demonstrate the inverse relationship between (manually applied) left vagal stimulation and ventricular excitation (R wave) rate during AF. As left vagal stimulation frequency was increased, ventricular excitation rate decreased. In these studies, a left vagal stimulus frequency of 0-10 per second reduced the ventricular excitation rate from > 200/min to < 50/min. The decreasing ventricular excitation rate with increasing left vagal stimulation frequency was universal, occurring in all 26 trials with the six subjects. This fundamental principle was used to construct an automatic controller for use in the second study, in which seven subjects were used to demonstrate that ventricular rate can be brought to and maintained within a targeted range with the use of an automatic (closed-loop) controller. A 45-minute record of automatic ventricular rate control is presented. Similar records were obtained in all seven subjects.     

静脉注射艾司洛尔与胺碘酮控制快速心房颤动患者心室率即时疗效的观察

目的　观察并比较静脉注射艾司洛尔与胺碘酮控制快速心房颤动患者心室率的有效性和安全性。方法　 5 8例快速心房颤动的患者 (心室率≥ 12 0次 /min ,心功能Ⅱ～Ⅳ级 ) ,随机分为两组 ,分别静脉注射艾司洛尔和胺碘酮。结果　艾司洛尔和胺碘酮控制快速心房颤动患者心室率的总有效率分别为 82 1%和 84 6 % (P >0 0 5 ) ,心室率平均下降幅度分别为4 4 %和 4 0 % (P >0 0 5 ) ,平均用药有效时间分别为 5 8± 3 1min和 2 4 6± 8 2min(P <0 0 1)。艾司洛尔组有 1例出现症状性低血压 ,1例出现心动过缓 ,无心衰加重表现。结论　静脉注射艾司洛尔能有效、迅速、安全地控制快速心房颤动患者心室率 ,尤其是合并器质性心脏病和心功能不全者。     

Continuous versus intermittent monitoring of ventricular rate in patients with permanent atrial fibrillation

Background: Ventricular rate control (VRC) is an important treatment strategy for patients with permanent atrial fibrillation (AF). We assessed the prevalence of poor VRC and the adequacy of various intermittent monitoring regimens to accurately characterize VRC during permanent AF. Methods: We retrospectively analyzed data from dual chamber implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT‐D) patients in the Medtronic Discovery? Link having permanent AF (AF burden >23 hours/day) and ≥365 consecutive days of device data. Poor VRC was defined as a day with the mean ventricular rate during AF >100 beats/minute (bpm) for ICD patients and >90 bpm for CRT‐D patients. Intermittent monitoring regimens were simulated from continuous device data by randomly selecting subsets of days in which data were available for analysis. Assessments of poor VRC were computed after replicating 1,000 simulations. Results: ICD (n = 1,902, age = 71 ± 10) and CRT‐D (n = 3,397, age = 72 ± 9) patients were included and followed for 365 days. The prevalence of poor VRC was 24.8% among ICD patients and 28.6% among CRT‐D patients. Significantly more patients were identified as having poor VRC with continuous monitoring compared to all intermittent monitoring regimens (sensitivity range = 8%–31%). Furthermore, 11.6% of ICD patients and 17.9% of CRT‐D patients experienced ≥7 days with poor VRC, to which the sensitivities of annual 7‐ and 21‐day recordings were <7% and <20%, respectively. Conclusions: A significant proportion of permanent AF patients experience poor VRC that would be missed with random intermittent monitoring. Whether improved knowledge of VRC with continuous monitoring will lead to improved outcomes compared to intermittent monitoring requires further study. (PACE 2012;1–7)     

Precipitation of ventricular fibrillation by intravenous diltiazem and metoprolol in a young patient with occult Wolff-Parkinson-White syndrome

We report the case of a young man who presented with a rapid, narrow-complex atrial fibrillation. A few hours after being administered intravenous metoprolol and diltiazem for rate control, he developed intermittent ventricular preexcitation on the electrocardiogram (ECG) and experienced ventricular fibrillation, from which he was successfully defibrillated. A subsequent electrocardiogram in sinus rhythm demonstrated previously unknown Wolff-Parkinson-White pattern. A left lateral accessory pathway was successfully ablated. Wolff-Parkinson-White syndrome should be included in the differential diagnosis when a young patient presents with atrial fibrillation, even if the ventricular complexes on the ECG are not preexcited.     

Comparison of intravenous ibutilide vs. propafenone for rapid termination of recent onset atrial fibrillation

This study was to evaluate the efficacy and safety of ibutilide and propafenone given intravenously in converting recent onset atrial fibrillation (AF). Eighty-two consecutive patients with AF (onset in 2 h to 90 days) were randomly assigned to receive two 10-min infusions, 10 min apart, of either ibutilide (1 mg) or propafenone (70 mg). The treatment was considered successful if sinus rhythm occurred within 90 min after the beginning of infusion. Ibutilide had a significantly higher rate of cardioversion than propafenone (70.73 vs. 48.78%, p = 0.043). The patients with shorter AF duration or smaller left atrium diameter had a higher success rate. Nonsustained monomorphic ventricular tachycardia was the most serious adverse effect of ibutilide in 9.76% of patients, and hypotension and heart pause were the major serious adverse events in 17.07% of patients treated with propafenone. Ibutilide is more effective than intravenous propafenone for the cardioversion of recent onset AF, and the adverse effects are rare and transient.