比索洛尔和胺碘酮治疗房颤的临床疗效

目的：观察比索洛尔和胺碘酮治疗心房颤动的临床疗效。方法：回顾性分析2005年3月～2009年11月50例房颤患者的临床资料,全部患者分为两组,分别给予比索洛尔和胺碘酮治疗观察对比两组患者房颤转复前后心室率、房颤转复的时间。结果：两组治疗房颤的转复成功率比较,差异无统计学意义（P〉0.05）;平均转复时间和用药后心室率比较,两组差异无统计学意义（P〉0.05）。结论：比索洛尔和胺碘酮治疗房颤,均有较高的转复成功率均可显著缩短转复时间及有效控制心室率。     

静脉注射胺碘酮治疗心力衰竭伴快速性心房颤动的疗效观察

目的观察心力衰竭伴快速性心房颤动患者静脉注射胺碘酮转复或控制心室率治疗心力衰竭的疗效,包括心房颤动的转复率、转复时间、心室率的控制、不良反应及安全性。方法心力衰竭伴快速性心房颤动患者48例,胺碘酮150mg加50g.L-1葡萄糖注射液20mL静脉注射,患者30min后房颤未转复即再应用1次,继以0.5～1mg.min-1维持静滴48h,观察用药后1,2,6,12,24和48h转复率、心室率、心力衰竭症状的缓解及不良反应。结果胺碘酮可快速有效使快速房颤转复为窦性心律,控制心室率,纠正心力衰竭,且无严重不良反应发生。结论心力衰竭伴快速性心房纤颤患者静脉注射胺碘酮治疗安全有效,尤其适用于合并器质性心脏病患者。     

静脉推注胺碘酮与西地兰转复阵发性心房颤动的疗效比较

目的:比较静脉应用胺碘酮与西地兰对阵发性心房颤动(AF)的转复及心室率控制情况。方法:47例阵发性AF患者随机分成胺碘酮组24例、西地兰组23例,分别静脉推注胺碘酮150～600mg、西地兰0.2～0.6mg,观察各组AF的转复、心室率变化情况及不良反应。结果:胺碘酮组转复有效率显著高于西地兰组(P<0.01);2组治疗前、后的平均心室率差异均有统计学意义(P<0.01),但胺碘酮组疗效更佳,且2组比较有显著性差异(P<0.01)。结论:胺碘酮转复心律有效率及心室率降低作用均优于西地兰,且副作用较少。     

胺碘酮治疗心房颤动的疗效观察

目的观察胺碘酮在治疗心房颤动中的临床疗效。方法将56例房颤患者,随机分成治疗组与对照组,治疗组给予胺碘酮治疗;对照组给予洋地黄治疗,观察复律及心室率情况。结果胺碘酮在转复窦性心律方面与对照组相比有显著性差异;在心室率方面两组比较无显著性差异。结论胺碘酮在转复房颤方面效果显著。     

胺碘酮和普罗帕酮治疗快速房颤的临床观察

目的：观察胺碘酮和普罗帕酮治疗快速心房颤动的临床疗效与安全性。方法46例快速房颤患者首先给予胺碘酮150mg静脉推注后，以1mg／min静脉维持6h、改为0．5mg／min静脉泵入24-48h，同时日服普罗帕酮150mg 3次／日，并在用药当天口服胺碘酮600mg／日，三天后改为200mg／日维持。结果24h内房颤转复15例，转复率32．6％，48h房颤转复35例，转复率76．8％，72h转复38例，转复率82．6％，应用胺碘酮与普罗帕酮后心室率明显下降，随时间延长呈减慢趋势，结论胺碘酮与普罗帕酮治疗快速房颤明显减慢心室率转复房颤安全有效。     

胺碘酮与普罗帕酮治疗阵发性快速心房颤动的临床疗效对比观察

目的:对比观察静脉应用胺碘酮与普罗帕酮治疗阵发性快速心房颤动的疗效。方法:选择32例患者,按就诊顺序随机分成胺碘酮和普罗帕酮两组,胺碘酮组16例:胺碘酮(可达龙)300mg微泵持续匀速1小时静脉输入,未转复窦性心律者以胺碘酮1mg/分持续静脉滴注5小时;普罗帕酮组16例:普罗帕酮70mg加生理盐水20ml,10分钟注射完毕,观察20分钟,未转复窦性心律者重复静脉注射普罗帕酮70mg,观察20分钟仍未转复者以普罗帕酮0.5mg/分持续静脉滴注,滴注时间不超过2小时。结果:转复率:胺碘酮组81.25%(13/16),普罗帕酮组75%(12/16),两组转复率比较差异无统计学意义(χ2=0.080,P=0.777)。转复时间:胺碘酮组(209±133)分钟,普罗帕酮组(166±128)分钟,两组转复时间比较差异有统计学意义(t=2.524,P=0.019)。转复后心室率比较:胺碘酮组(69.8±12.2)次/分,普罗帕酮组(83.5±19.7)次/分,两组转复后心室率比较差异有统计学意义(t=-2.794,P=0.010)。结论:胺碘酮和普罗帕酮对阵发性快速心房颤动均有较高的转复率,转复时间普罗帕酮短于胺碘酮,转复后心室率胺碘酮较普罗帕酮慢。     

胺碘酮治疗急性心肌梗死并发心房颤动临床观察

目的探讨静脉应用胺碘酮治疗急性心肌梗死并发快速心房颤动的有效性和安全性。方法26例急性心肌梗死并发快速心房颤动患者，静脉推注负荷量胺碘酮之后持续静脉滴注维持48h。观察心房颤动转复、心室率、血压变化及不良反应。结果心房颤动2、24、48h转复率分别为46．2％、84．6％、92．3％。用药后心室率与治疗前比较差异有统计学意义（P〈0．01），血压水平同治疗前相比差异无统计学意义（P〉0．05）。1例出现心动过缓，停药后恢复正常心律；2例未能转复，1例为严重心衰患者，1例因静脉炎停用。结论静脉滴注胺碘酮治疗急性心肌梗死并发快速心房颤动安全、有效。     

比索洛尔和胺碘酮治疗房颤的临床疗效

目的 观察记录比索洛尔和胺碘酮治疗心房颤动的临床疗效.方法 分别应用比索洛尔和胺碘酮来治疗房颤;按其药物的使用情况分为比索洛尔组和胺碘酮组.观察两组患者房颤转复前后心室率和血压的变化情况、房颤转复的时间和药物的不良反应,并将两组进行对比分析.结果 两组治疗房颤的转复成功率比较差异无显著性（P〉0.05）;平均转复时间、用药后心室率和血压降低情况的比较,两组也不存在显著差异（P〉0.05）.结论 无论应用比索洛尔还是胺碘酮治疗房颤,均有较高的转复成功率、显著缩短的转复时间以及有效的心室率控制,都可以作为临床上治疗房颤的一线药物.     

静脉注射胺碘酮转复快速心房颤动疗效的临床观察

目的观察静脉注射胺碘酮转复快速心房颤动的治疗效果及其安全性。方法对90例快速心房颤动患者给予胺碘酮150mg加5%葡萄糖液10mL静脉注射,10min注射完毕,观察30min后未转复可重复应用,继以0.5～1mg/min维持静脉滴注24h,观察用药后2、6、12、24h转复率、心室率、不良反应。结果用药2h内转复率30.0%(27/90),6h内转复率55.6%(50/90),12h内转复率70.0%(63/90),24h内转复率82.2%(74/90),且用胺碘酮期间并未出现严重不良反应。结论静脉注射胺碘酮转复新发快速心房纤颤安全有效,尤其适用于合并器质性心脏病的患者。     

老年心功能不全伴心房颤动患者静脉用胺碘酮治疗的评估与观察

目的探讨老年心功能不全伴心房颤动患者静脉用胺碘酮治疗的用药安全。方法对76例老年心功能不全伴心房颤动患者静脉用胺碘酮时进行用药前评估;用药方案正确实施;用药后疗效判断;用药后不良反应观察与处理4个方面进行评估与观察。结果76例老年心功能不全伴心房颤动患者静脉用胺碘酮治疗,阵发性心房颤动52例,持续心房颤动24例。复律成功55例(72%),未转复为窦性心律21例(28%)。13例(17%)患者出现低血压,立即停止静脉用胺碘酮并使用升压药物多巴胺干预后恢复正常。7例(9%)患者应用胺碘酮转为窦性心律后,出现窦性心动过缓,4例患者出现快慢综合征,3例患者出现间歇性的慢心室率(长R-R间期)。7例(9.21%)患者停静脉用胺碘酮后给予阿托品药物治疗,4例患者心率恢复正常,有3例患者安装永久性心脏起搏器。结论加强对老年心功能不全伴心房颤动患者,静脉用胺碘酮治疗的评估与观察。早期发现不良反应及时处理,对患者用药安全有重要的意义。     

胺碘酮静脉给药治疗心房纤维颤动患者引致休克的临床特点

目的：探讨胺碘酮静脉给药治疗心房纤维颤动患者引起休克的临床特点。方法：收集2003年至2007年中文医学文献关于胺碘酮静脉给药治疗心房纤维颤动患者引致休克的临床资料，包括患者的基础心脏病，心房纤维颤动发作时的心律、心率、血压、心功能状态、心电图以及胺碘酮的用法用量。对胺碘酮输液的浓度、静脉滴注速度和总剂量以及休克发生的时间、表现和处理进行分析。结果：共收集7例胺碘酮所致休克患者的临床资料，其中2例来自本院。胺碘酮溶于5％葡萄糖注射液100ml中，浓度为1．5～7．5mg／ml，静脉给药速度为2．5～10mg／min。用药后休克发生的时间，4例为2min内，3例为5～20min内，持续时间为3～120min。2例休克患者伴有意识障碍，5例患者休克时仍有心房纤维颤动。结论：胺碘酮静脉给药可能引起休克，临床表现危重，及时对症治疗可缓解。     

重症患者阵发心房颤动伴快速心室率的治疗方法研究

目的:观察病因治疗能否使重症监护病房中阵发心房颤动(简称房颤)患者转复窦律;比较静脉注射毛花苷丙-胺碘酮序贯治疗与单独注射胺碘酮转复无心脏病基础的房颤效果。方法:42例发作阵发性房颤伴快速心室率的危重症患者进行病因治疗,对未纠律者随机分配至毛花苷丙-胺碘酮序贯治疗与单独胺碘酮治疗组。结果:病因治疗后23例患者转复窦律。余19例患者进行随机分组,2组胺碘酮用量差异无统计学意义(P=0.386),心率变化差异无统计学意义(P=0.974),复发率差异无统计学意义(P=0.85)。结论:病因治疗可转复危重症患者房颤心律。对病因治疗不能纠律者,直接静脉注射胺碘酮效果与毛花苷丙-胺碘酮序贯治疗相同。     

Amiodarone - waxed and waned and waxed again

Amiodarone has been used as an anti-arrhythmic drug since the 1970s and has an established role in the treatment of ventricular tachyarrhythmias. Although considered to be a class III anti-arrhythmic, amiodarone also has class I, II and IV actions, which gives it a unique pharmacological and anti-arrhythmic profile. Amiodarone is a structural analogue of thyroid hormone and some of its anti-arrhythmic properties and toxicity may be attributable to interactions with nuclear thyroid hormone receptors. The lipid solubility of amiodarone gives it an exceptionally long half-life. Oral amiodarone takes days to work in ventricular tachyarrhythmias, but iv. amiodarone has immediate effect and can be used in life threatening ventricular arrhythmias. Intravenous amiodarone administered after out-of-hospital cardiac arrest due to ventricular fibrillation improves survival to hospital admission. Many survivors of myocardial infarction (MI) die during the subsequent year, probably due to ventricular arrhythmia. Amiodarone reduces sudden death after MI and this benefit is predominantly observed in patients with preserved cardiac function. Sudden cardiac death, predominantly due to ventricular arrhythmias, is also commonly seen in patients with heart failure. The Grupo de Estudio de la Sobrevida en lsuficiencia Cardiaca en Argentina (GESICA) and Estudio Piloto Argentino de Muerte Subita y Amiodarona (EPAMSA) trials showed survival benefit of amiodarone in heart failure, whereas Congestive Heart Failure-Survival Trial of Anti-arrhythmic Therapy (CHF-STAT) did not. Subsequent meta-analysis established a survival benefit of amiodarone in heart failure. Implanted Cardioverter Defibrillators (ICDs) also give survival benefit to patients at risk of sudden death. In patients with a history of ventricular fibrillation or haemodynamically-compromising ventricular tachycardia, ICDs have been shown to be superior to anti-arrhythmic drugs, principally amiodarone. Further analysis has been undertaken to ascertain which patients are most likely to benefit from ICDs, as these are more expensive than treatment with amiodarone. Patients with severely depressed ejection fractions should be the first to be considered for ICDs. A new indication for amiodarone is atrial fibrillation or flutter. Amiodarone is effective in chronic and recent onset atrial fibrillation and orally or iv. for atrial fibrillation after heart surgery. In atrial fibrillation amiodarone is more than or equi-effective with flecainide, quinidine, racemic sotalol, propafenone and diltiazem and therefore should be considered for first line therapy. Amiodarone is also safe and effective in controlling refractory tachyarrhythmias in infants and is safe after cardiac surgery.     

Amiodarone -- waxed and waned and waxed again

Amiodarone has been used as an anti-arrhythmic drug since the 1970s and has an established role in the treatment of ventricular tachyarrhythmias. Although considered to be a class III anti-arrhythmic, amiodarone also has class I, II and IV actions, which gives it a unique pharmacological and anti-arrhythmic profile. Amiodarone is a structural analogue of thyroid hormone and some of its anti-arrhythmic properties and toxicity may be attributable to interactions with nuclear thyroid hormone receptors. The lipid solubility of amiodarone gives it an exceptionally long half-life. Oral amiodarone takes days to work in ventricular tachyarrhythmias, but iv. amiodarone has immediate effect and can be used in life threatening ventricular arrhythmias. Intravenous amiodarone administered after out-of-hospital cardiac arrest due to ventricular fibrillation improves survival to hospital admission. Many survivors of myocardial infarction (MI) die during the subsequent year, probably due to ventricular arrhythmia. Amiodarone reduces sudden death after MI and this benefit is predominantly observed in patients with preserved cardiac function. Sudden cardiac death, predominantly due to ventricular arrhythmias, is also commonly seen in patients with heart failure. The Grupo de Estudio de la Sobrevida en lsuficiencia Cardiaca en Argentina (GESICA) and Estudio Piloto Argentino de Muerte Subita y Amiodarona (EPAMSA) trials showed survival benefit of amiodarone in heart failure, whereas Congestive Heart Failure-Survival Trial of Anti-arrhythmic Therapy (CHF-STAT) did not. Subsequent meta-analysis established a survival benefit of amiodarone in heart failure. Implanted Cardioverter Def ibrillators (ICDs) also give survival benefit to patients at risk of sudden death. In patients with a history of ventricular fibrillation or haemodynamically-compromising ventricular tachycardia, ICDs have been shown to be superior to anti-arrhythmic drugs, principally amiodarone. Further analysis has been undertaken to ascertain which patients are most likely to benefit from ICDs, as these are more expensive than treatment with amiodarone. Patients with severely depressed ejection fractions should be the first to be considered for ICDs. A new indication for amiodarone is atrial fibrillation or flutter. Amiodarone is effective in chronic and recent onset atrial fibrillation and orally or iv. for atrial fibrillation after heart surgery. In atrial fibrillation amiodarone is more than or equi-effective with flecainide, quinidine, racemic sotalol, propafenone and diltiazem and therefore should be considered for first line therapy. Amiodarone is also safe and effective in controlling refractory tachyarrhythmias in infants and is safe after cardiac surgery.     

胺碘酮与坎地沙坦合用治疗非瓣膜病阵发性房颤的临床观察

目的：观察胺碘酮与坎地沙坦对预防非瓣膜病心房颤动复发的临床疗效。方法：将60例阵发性房颤患者随机分为治疗组30例和对照组30例,治疗组口服胺碘酮加坎地沙坦,对照组口服胺碘酮治疗,观察窦性心律的维持情况。结果：治疗组和对照组相比,阵发性房颤的发生率明显降低（P〈0．05）。结论：胺碘酮与坎地沙坦合用对预防非瓣膜病心房颤动的复发有较好的疗效。     

胺碘酮治疗冠心病心房颤动的疗效和安全性观察

目的:观察胺碘酮治疗冠心病心房颤动(以下简称房颤)的疗效和安全性。方法:将我院58例房颤患者纳为研究对象,男性38例,女性20例,其中阵发性房颤45例,持续性房颤13例。给予胺碘酮2周内负荷量为7 g,维持量为0.2 g.d-1。结果:随访0.3～6.8年,平均(3.5±1.5)年。显效42例(73.0%),有效8例(13.8%),总有效率为86.1%。其中,皮肤过敏3例(5.0%),四碘甲状腺原氨酸(T4)升高3例(5.1%),促甲状腺激素(TSH)降低2例(3.2%),TSH升高4例(6.9%),间质性肺病1例(1.7%),恶心、腹胀5例(8.6%),视力模糊3例(5.1%)。结论:胺碘酮治疗冠心病房颤疗效高、相对安全,但要注意早期发现及处理甲状腺和肺毒副作用。     

静脉应用胺碘酮治疗心房颤动复律的疗效观察

目的:观察静脉应用胺碘酮对心房颤动复律的临床疗效。方法:将172例心房颤动患者随机分为胺碘酮组和安慰剂组。胺碘酮组(n=87)静脉推注胺碘酮5mg·kg-1,再以胺碘酮10～20mg·kg-1·d-1加入0.9%氯化钠注射液中持续静脉滴注,维持直至恢复为窦性节律;安慰剂组(n=85)静脉推注和静脉滴注0.9%氯化钠注射液,并给予控制心室率治疗。观察2组复律成功率和复律时间。结果:胺碘酮组有74例(85.1%)恢复为窦性节律,安慰剂组有68例(80.0%)恢复为窦性节律,2组比较差异无统计学意义(P>0.05)。胺碘酮组心房颤动持续时间短于安慰剂组(P<0.01)。胺碘酮组1例患者出现窦性心动过缓,停药后恢复。结论:胺碘酮静脉应用不能提高复律率,但能缩短心房颤动持续时间。     

2种用药方案治疗心房颤动的成本-效果分析

目的:比较胺碘酮与索他洛尔治疗心房颤动(AF)的成本与效果。方法:102例患者均分成A、B组,分别给予胺碘酮、索他洛尔治疗,并进行成本-效果分析。结果:2组成本分别为2714.18、2176.56元,有效率分别为78.43%、70.59%(P<0.01),不良反应发生率分别为13.73%、19.61%(P<0.01)。结论:胺碘酮转复房颤有效率与索他洛尔相当,但维持窦律疗效优于索他洛尔,对心脏毒副作用小于索他洛尔。     

胺碘酮治疗老年充血性心力衰竭合并心房颤动的临床观察

目的:观察胺碘酮治疗老年充血性心力衰竭(CHF)合并心房颤动的临床疗效。方法:将我院2004-2010年90例年龄≥65岁的CHF并心房颤动患者,随机1:1分为治疗组与对照组,对照组给予强心利尿等常规治疗;治疗组在常规治疗的基础上加用胺碘酮,并对其进行随访,观察疗效。结果:治疗组总有效率为95.56%;对照组总有效率为68.89%,2组比较差异有统计学意义(P<0.05)。2组均未见严重不良反应发生。结论:胺碘酮治疗老年CHF合并心房颤动既能有效控制心室率,又能显著改善心功能,且不良反应少。