胺碘酮对心力衰竭合并慢性房颤的疗效与安全性观察

观察胺碘酮控制快速房颤对心室率的影响及长期服用对心功能的影响，选择各种心脏病的房颤患者88例，分别给予胺碘酮及阿替洛尔，长期口服观察其心功能及活动与静息时心室率变化。胺碘酮组心室率改善较阿替洛尔相比无差异性(P＜0．05)且无明显心功能加重。     

胺碘酮转复心房颤动31例报告

应用小剂量胺碘酮转复心房颤动３１例，患者口服胺碘酮，负荷剂量６００ｍｇ／ｄ＊７ｄ，维持量为２００ｍｇ／ｄ，４Ｗ后结果显示，２３例转复为窦性心律，不良反应轻微。表明在严格的病例选择，严密监测的前提下，服用小剂量胺碘酮转复房颤是有效而安全的。     

静脉注射胺碘酮治疗房颤伴快心室反应28例分析

目的：观察房颤伴快心室反应的患者静脉注射胺碘酮的安全性和有效性。方法：对心房颤动伴快心室反应的28例心脏病患者，首次静脉注射胺碘酮150mg，20min后无效时重复应用，仍无效用微泵量静脉维持600μg／min，持续24h。结果：负荷量为150～300（206±42）mg，转复成功率85．7％，副作用发生率14．2％。结论：静脉注射胺碘酮治疗房颤伴快心室反应的患者是有效且较安全的方法。     

胺碘酮转复阵发心房颤动的疗效观察

目的对比胺碘酮和毛花甙C治疗阵发心房颤动（房颤）的疗法。方法阵发性房颤,随机分为胺碘酮组（30例）和毛花甙C组（29例）,胺碘酮组静脉注射胺碘酮150～300mg,随后以1mg／min的滴速予以静滴;毛花甙C组静脉注射0．4—0．8mg,观察其复律情况、心室率的变化、QT间期及药物副作用。结果毛花甙C组阵发房颤29例,复律成功14例;胺碘酮组30例,复律成功23例,两组未复律者心室率均有明显控制,QT间期及副作用差异无显著性意义。胺碘酮组复律平均时间为5．1h,毛花甙C组复律平均时间为3．5h。结论阵发性房颤的复律疗效胺碘酮高于毛花甙C。     

静脉注射胺碘酮、美托洛尔控制心房颤动时快速心室率的临床评价

目的观察胺碘酮、美托洛尔静脉制剂用于控制心房颤动时快速心室率的临床疗效和安全性。方法82例持续性房颤患者分别接受静脉胺碘酮（A组）和美托洛尔（B组）治疗。结果两组患者治疗后心室率明显降低，A组42例，心室率平均下降（27±7）次／min，B组40例，心室率平均下降（26±9）次／min，美托洛尔组有4例用药后心力衰竭加重，1例发生窦性停搏5．2S，不良反应发生率12．5％，而胺碘酮组所有患者未因药物副作用而终止治疗。结论胺碘酮和美托洛尔静脉应用均能较好控制心房颤动时的快速心室率，胺碘酮较美托洛尔更安全。     

胺碘酮预防食管癌及贲门癌开胸术后心房颤动的疗效观察

目的：探讨胺碘酮对食管癌、贲门癌开胸术后心律失常的预防作用。方法：167例食管癌、贲门癌的患者随机分为两组,预防组83例术前口服胺碘酮,开始为200 mg,3次/d,连服5 d后,改为200 mg/d至手术前,术后静脉使用胺碘酮,能进食后改200 mg/d口服。对照组84例,不予胺碘酮预防,观察两组患者术后各种并发症情况,房颤发生率及心室率的变化。结果：预防组房颤发生率、房颤时心室率均低于对照组,分别为6.0%vs 13.1%;（112±10.5）次/min vs（135±15.3）次/min,P均〈0.05。结论：胺碘酮能安全有效降食管癌、贲门癌开胸术后房颤的发生率,减慢房颤发生时的心室率。     

洋地黄与胺碘酮治疗快速房性心律失常疗效分析

目的：探讨洋地黄与胺碘酮在治疗快速房性心律失常的作用机制及安全性的比较。方法：56例因心血管疾病合并快速房性心律失常住院的病人，随机分为洋地黄组与胺碘酮组。结果：在胺碘酮组与洋地黄组比较中，阵发性房颤、房扑两组差异有显著性（P〈0．005，而持续性房颤、房扑两组比较差异无显著性（P〉0．05）。结论：在阵发性房颤、房扑治疗中，胺碘酮组复律显著，是理想的治疗选择。在持续性房颤、房扑治疗中，两组疗效差异无显著性，表明胺碘酮以复律为主，兼有降低心室率作用。洋地黄制剂可降低心室率，改善症状。     

胺碘酮转复快速阵发性房颤30例分析

本文通过对2004—05／2007—05齐齐哈尔市第一医院急诊内科观察收治的30例患者静脉注射胺碘酮转复阵发性房颤进行临床疗效观察研究,从而了解静脉注射胺碘酮转复阵发性房颤的疗效,并评价其减慢心室率的作用及安全性。     

房颤或房扑病人行心内直视手术在主动脉开放后静脉注射胺碘酮的效用

目的：观察术前存在房颤或房扑病人行心内直视手术在主动脉开放后静脉注射胺碘酮的作用及对血流动力学的影响。方法：选择术前存在房颤和房扑病人行心内直视手术100例，随机分为胺碘酮组（A组，在主动脉开放、自主心跳已恢复、并减少腔静脉回流的部分循环始10min内经静脉推注胺碘酮150mg，其后24h静脉滴注10mg／kg）和对照组C组，将胺碘酮替换为安慰剂。监测心电图、桡动脉压（ASP）、中心静脉压（CVP）、心输出指数（CI）以及中心静脉压（CVP），随访术后情况。结果：房颤的转复率与房颤病史密切相关。两组心律转复成功率有显著差异（P〈0．05），且A组与c组比较心率较慢（P〈0．01），CVP较低（P〈0．05），CI较高（P〈0．05）而ICU滞留时间较短（P〈0．01）。结论：在主动脉开放且自主心跳已恢复后静脉给予胺碘酮，对原有房颤或房扑病人，心内直视手术后心律转复成功率有显著作用，并能更好控制心室率，从而达到较好稳定血流动力学的效果并改善病人的预后。     

胺碘酮治疗慢性心力衰竭合并快速房颤的疗效和安全性

目的探讨胺碘酮治疗慢性心力衰竭（CHF）合并快速房颤的疗效和安全性。方法选择CHF合并快速房颤患者42例。在治疗心脏原发病及心力衰竭的基础上给予胺碘酮，静脉首次负荷量150mg，加入生理盐水20mL，在10～15min内注射完毕，视效果10～15min后再给予50～150mg静注，后以0．5～1．0mg／min维持；同时口服胺碘酮0．2g，3次／d，5～7d；0．2g，2次／d，5～7d；0．2g，1次／d维持，观察其临床疗效和安全性。结果42例快速房颤总转复33例（78．5％）。未能复律的9例，心室率亦下降至72～90（83．2±14．1）次／min（P〈0．05）；心功能改善至Ⅱ级28例，Ⅰ级14例；3例出现低血压，2例出现Ⅰ度房室传导阻滞，4例出现恶心、腹胀。结论胺碘酮对慢性心力衰竭合并快室率房颤有效且安全。     

围术期应用胺碘酮预防心脏不停跳冠状动脉搭桥术后房颤的研究

目的探讨围手术期应用胺碘酮在预防非体外循环下心脏不停跳冠状动脉搭桥术后房颤中的作用。方法采用随机对照的研究方法,将2009年1月至2011年1月在我科进行非体外循环下心脏不停跳冠状动脉搭桥术的患者随机分为试验组和对照组,每组各100例。A组为试验组,术前口服胺碘酮,600mg/d(200mgtid),连续7d,之后改为200mg/d至术前,术后当天开始静脉滴注胺碘酮,负荷量为5mg/kg,之后给予维持量0.5mg.kg-1.h-1,能进食后改为200mg/d口服。B组为对照组,不给予胺碘酮治疗而仅用常规药物。观察两组患者术后房颤发生率及心率变化,同时检测试验组患者术前及术后第2天的胺碘酮血药浓度。结果两组患者的术前一般特征及手术情况相近。试验组100例患者中术后有10例(10.0%)发生房颤,对照组100例患者中有36例(36.0%)发生房颤(P=0.015)。试验组房颤时最大心室率为(126.0±20.8)次/min,房颤持续时间为1.0d,对照组房颤时最大心室率为(150.0±25.6)次/min,房颤持续时间为(3.0±1.5)d(P<0.05)。试验组术后心率慢于对照组,两组Q-T间期、术后并发症的发生及死亡率无统计学差异。试验组的住院时间为(10.6±2.8)d,对照组住院时间为(15.4±3.2)d(P<0.05)。胺碘酮血药浓度平均值术前为(797±136)ng/ml,术后第2天为(763±94)ng/ml(P>0.05)。结论胺碘酮在预防非体外循环下心脏不停跳冠状动脉搭桥术后房颤中的作用显著,能安全有效地降低术后房颤的发生率,缩短房颤持续时间,且无明显不良反应。     

胺碘酮转复心房颤动的疗效分析

目的观察重叠应用静脉及口服胺碘酮治疗并发于器质性心脏病的心房颤动的临床疗效及安全性。方法39例心房颤动患者先给予静脉负荷量胺碘酮(150~300 mg)后,继之以0.6 mg/min静脉点滴维持48 h;同时口服胺碘酮治疗,2周内给胺碘酮负荷量7 g,然后维持量0.2 g/d。观察临床疗效及不良反应。结果32例(82.1%)患者成功转复为窦性心律,于2 h、2~24 h、24~48 h、2~7 d转复率分别为12.8%、28.2%、23.1%、18.0%。未转复组患者左房径大于转复组(P<0.05),而射血分数明显低于转复组(P<0.05),这可能是7例患者未转复的原因。2例患者用药后出现窦性心动过缓,1例出现恶心、腹胀,经减药后恢复。结论静脉及口服胺碘酮治疗并发于器质性心脏病的心房颤动是有效且较安全的方法。     

A formula for the stratified selection of patients with paroxysmal atrial fibrillation in the emergency setting: a retrospective pilot study

Background: Amiodarone is a commonly used medication in the treatment of atrial fibrillation (AF) of recent onset. Study Objectives: The aim of the study was to identify a possible formula for selecting Emergency Department (ED) patients with paroxysmal AF who will spontaneously restore sinus rhythm (SR), successfully restore SR with the use of loading intravenous (i.v.) amiodarone, or require 24-h maintenance amiodarone infusion. Methods: This retrospective pilot study included 141 patients with recent-onset AF. Patients who did not restore SR spontaneously received i.v. amiodarone (5 mg/kg) within a period of 30 min. In case of no response, an additional dosage of 1000 mg of i.v. amiodarone was administered over a period of 24 h. Binary logistic regression models were used to determine the predictors of spontaneous conversion and the response to amiodarone administration. Results: The formula ([heart rate/systolic blood pressure] + 0.1 × number of past AF incidences) was chosen as the one with the highest combined sensitivity and specificity. This index identified the patients who spontaneously restored SR (cutoff point 1.31 with 78.6% sensitivity and 77.9% specificity), whereas for patients who responded to the loading i.v. amiodarone dose, the use of the index (cutoff point 1.24) exhibited 84.1% sensitivity and 75.3% specificity. Conclusions: This formula may be a useful and reliable bedside diagnostic tool to identify AF patients most likely to spontaneously convert, or respond to loading amiodarone administration in the emergency setting. The use of this index also can assist in patient risk stratification.     

伊布利特与胺碘酮对阵发性房颤复律的疗效比较

[目的]研究Ⅲ类抗心律失常药物依布利特与胺碘酮转复阵发性心房颤动（房颤） 的有效性及安全性.[方法]入选阵发性房颤患者63例（男32例,女31例）,随机进入依布利特组（n=28）、胺碘酮组（n=35）.前者于10 min内静脉注射依布利特1 mg,如给药结束10 min后仍未转复为窦性心律, 重复前述治疗1次.后者于10 min内静脉注射胺碘酮150 mg,后以1 mg/min维持6 h,再以0.5 mg/min维持18 h,转复后即刻停药.观察给药后房颤的转复率、转复时间、心室率、QTc变化及不良反应.[结果] 依布利特组转复率明显高于胺碘酮组（67.9% vs 40.0%,P=0.028）,转复时间明显短于胺碘酮组[（20.11±11.54） min vs （523.31±277.73） min,P=0.000];伊布利特组10 min、30 min时对心室率和QTc影响大于胺碘酮组（P〈0.05）.胺碘酮组有2例出现轻度低血压,1例胃肠炎,伊布利特组出现2例单形室性心动过速,两组患者不良反应率差异无统计学意义（P〉0.05）.[结论] 伊布利特转复阵发性房颤疗效高于胺碘酮,转复时间短,是一种转复房颤快速、有效的药物,但用药前后必须加强心电监护.     

Efficacy and Safety of Low Doses of Beta-Blocker Agents Combined with Amiodarone in Refractory Ventricular Tachycardia

Twenty patients aged 55 ± 16 years with 40 chronic ventricular tachycardias (VT) refractory to 4.6 ± 1.9 antiarrhythmic drugs, used alone or in combination, were managed by low doses of beta-blocker agents combined with oral amiodarone (Am), either after loading (1.2 g for 7 days, n: 5) or reloading (1.2 g for 4 days, n: 15) of Am. All patients proved refractory to Am alone. Seven VT were also refractory to endocardial catheter fulguration in six patients. Thirteen patients had coronary artery disease, three had arrhythmogenic right ventricular dysplasia, two had dilated cardiomyopathy, one had valvular disease, and one had no structural heart disease. Ten patients had an EF <30%. Ten patients were in NYHA functional class three. VT was permanent in three patients, daily in three, weekly in seven, paroxysmal in seven. In 11 patients, VT occurred both at day and night. In 11 patients, decrease of the sinus cycle preceeded VT. Oral administration of a daily low dose of a beta blocker agent (acebutolol 100 mg, betaxolol 5–10 mg, metoprolol 50 mg, nadolol 20–40 mg, pindolol 2.5 mg, propanolol 30 mg, sotalol 80–160 mg, terta-tolol 2.5 mg) combined with 400 mg/day of Am suppressed VT episodes in all patients. None presented heart failure or collapse. The mean reduction of the heart rate was 15% (65 to 55/min). At discharge, exercise ECG (n: 14) induced non sustained VT in two patients. At programmed electrical stimulation (PES) (n: 15), VT was no longer inducible in 4 patients, was slower, well-tolerated in nine patients, and remained inducible at the same rate in only two patients. Chronic treatment prevents recurrence of VT in 19 patients during a follow-up of 14 ± 9 months (range 2 to 33). Conclusions: (1) beta blockers agents and Am have strong synergistic effects; (2) antiarrhythmic treatment with low doses of beta blockers could be managed by PES; (3) at the doses used in (his study, all beta blockers presented the same safety; (4) combination of low doses of beta blockers agents with chronic Am therapy inhibit VT.     

Antiadrenergic therapy in the control of atrial fibrillation

Atrial fibrillation (AF) in heart failure develops commonly in older individuals and its prevalence increases as heart failure severity progresses. Because of deteriorating hemodynamics, patients with heart failure are at increased risk for developing AF and, conversely, AF in heart failure patients is associated with adverse hemodynamic changes. AF is believed to increase the mortality risk in heart failure, which may be minimized by treatment that includes the control of ventricular rate, prevention of thrombotic events, and conversion to normal sinus rhythm. Clinical guidelines recommend amiodarone or dofetilide in heart failure patients, but these drugs have certain drawbacks, such as an increased risk for bradyarrhythmias with amiodarone and proarrhythmic reaction with dofetilide. Some but not all clinical trials have suggested that rate control should be the primary therapeutic goal in high-risk heart failure patients with AF and, if unsuccessful, followed by rhythm control. The former is effectively achieved with rate-lowering beta-blockers alone or in combination with digoxin. Recent studies evaluating the effects of combination carvedilol/digoxin therapy demonstrate synergistic effects between the two drugs. This combination therapy decreased heart failure symptoms, effectively reduced ventricular rate, and improved ventricular function to a greater extent compared with that produced by either drug alone. Although digoxin alone is an effective heart failure treatment, its use as a single rate-control therapy is often ineffective in heart failure patients with AF associated with rapid ventricular response. Carvedilol is effective, alone or in combination, with digoxin in such heart failure patients with AF, and has been shown to reduce mortality risk in patients with chronic heart failure during prolonged therapy.     

倍他乐克和小剂量胺碘酮对维持房颤复律后窦律的疗效观察

目的：应用倍他乐克和小剂量胺碘酮，观察对房颤转复及维持窦性心律的效果。方法：开始用胺碘酮持续静注，48h后改用口服，按每天600mg，400mg，200mg每周减量；倍他乐克每天25～50mg起始，每周25～50mg增量，以心率和血压作为控制标准。结果：23例药物转复成功，6例电转复成功；0．5a、1a、2a有效率93．31％(27／29)，89．66％(26／29)，86．21％(25／29)，无明显副作用发生。结论：联合小剂量胺碘酮和倍他乐克维持房颤转复后的窦性心律．比单用胺碘酮疗效好，观察2a未发现明显副作用。认为：除两药的抗心律失常作用外，长期应用更有综合改善心功能的作用，更有利于对冠心病、高血压心脏病、心肌病合并房颤的治疗。     

不同剂量、剂型美托洛尔对急慢性房颤控制和术后房颤防治的卫生技术评估

目的对不同剂量、剂型的美托洛尔在控制慢性房颤快室率和预防术后房颤发生方面的疗效和安全性进行评估。方法采用卫生技术评估方法，全面检索PubMed（1966～2006）、EMbase（1980～2005）、Cochrane图书馆（2006年第3期）和中文生物医学期刊数据库，及各国心血管专业数据库和不良反应中心等数据库，依据纳入和排除标准筛选文献，评价纳入文献质量，并提取有效数据进行分析。结果针对慢性快室率房颤，静脉注射美托洛尔10～15mg能有效控制其快室率，但〈10mg则不能达到最大疗效，而〉15mg临床疗效亦未见提高，且副作用有增加；口服美托洛尔100mg／d较50mg／d在静息和运动时对慢性房颤患者的心室率控制更好；预防术后房颤研究显示，口服美托洛尔150mg／d组术后房颤发生率和住院时间均较100mg／d组有下降趋势；静注20mg组及30mg组术后房颤发生率显著低于10mg组；且静滴美托洛尔与口服美托洛尔相比，术后48h内房颤发生率明显降低。各国药物不良反应中心的数据显示美托洛尔不良反应低。目前尚缺乏不同人种在剂量变化上的安全性研究。结论现有研究认为，大剂量美托洛尔的疗效优于小剂量，但缺乏高质量证据，有待于针对性强的临床试验进一步证实。在安全性生上两者无差别。     

小剂量地高辛并美托洛尔控制老年房颤心室率的临床观察

目的　观察小剂量地高辛并美托洛尔控制老年房颤心室率的疗效和安全性。方法　对 4 4例有器质性心脏病的老年房颤患者用地高辛 0 12 5mg/d和美托洛尔 12 5～ 2 5mg/d治疗。结果　心室率由治疗前 116 4 4± 16 30次 /min降至 72 89± 18 70次 /min(P <0 0 5 )。Holter结果显示日平均心室率为 74 89±2 2 77次 /min ,最慢心率 5 3 89± 17 4 9次 /min ,最快心率 12 1 12± 2 4 33次 /min。结论　小剂量地高辛并美托洛尔可安全、有效地控制老年房颤心室率     

"Torsade de pointes" in patients with structural heart disease and atrial fibrillation treated with amiodarone, beta-blockers, and digitalis

Amiodarone is one of the most efficient and safe antiarrhythmic drugs in the treatment of atrial fibrillation (AF). Yet, though rare, proarrhythmic effects remain a clinical problem. We present three cases of amiodarone-associated "Torsade de pointes" tachycardia (Tdp) in patients treated concomitantly with heart rate controlling medication for AF. Amiodarone loading therapy was started for the treatment of tachyarrhythmic AF in all the three patients. All presented with a history of coronary heart disease, resulting in a severely reduced left ventricular ejection fraction in two patients. One received oral amiodarone loading, in the others, amiodarone was administered intravenously because of hemodynamically relevant AF episodes. Amiodarone therapy was combined with a heart rate controlling medication including a β-blocking agent and digitalis in all the cases. All the subjects suffered from clinically relevant Tdp in the early run after initiation of amiodarone loading (max. 48 hours). The mean QTc in all patients before induction of Tdp was prolonged. The present case reports imply that amiodarone in combination with β-blocker/digitalis therapy may be associated with an elevated proarrhythmic risk in selected patients with structural heart disease and AF.