联合使用西地兰及镁离子极化液控制风湿性心脏病快速房颤心室率的疗效观察

目的探讨风湿性心脏病二尖瓣狭窄并发快速房颤(AF)患者在应用西地兰基础上加用镁离子极化液控制心室率的治疗效果。方法将风湿性心脏病二尖瓣狭窄并快速房颤32例按治疗方法不同随机分为观察组和对照组,观察组应用西地兰加镁离子极化液,对照组仅用西地兰控制心室率。测定2组心室率控制于理想水平所需时间(静息心室率60~80次/分,运动心室率<115次/分)。结果观察组与对照组比较,心室率控制在上述范围所需时间分别是(8.0±1.92)h、(8.62±2.76)h,2组比较差异有统计学意义(P<0.01)。结论联合使用西地兰级镁离子极化液可有效控制快速房颤心室率。     

胺碘酮对老年急性心肌梗死合并心房颤动患者短期预后影响研究

目的探讨胺碘酮对老年急性心肌梗死(AMI)合并心房颤动(AF)患者短期预后的影响。方法选择我院2012年1月至2014年12月收治的87例老年AMI合并AF患者作为研究对象,按照随机数字表法分为观察组(45例)和对照组(42例),观察组给予胺碘酮治疗,对照组给予毛花苷丙治疗。比较2组患者AF控制率、窦性心律维持效果、心室率和血压变化情况以及不良反应发生率。结果治疗后6、12、24、48h,观察组AF控制率均显著高于对照组(均P<0.05);AF转复后1个月内,观察组窦性心律维持总有效率为84%,显著高于对照组的55%(P<0.05);2组患者治疗后心室率均明显降低(P<0.05),组间比较差异无统计学意义(P>0.05);观察组不良反应发生率为7%,显著低于对照组的26%(P<0.05)。结论胺碘酮显著提高了老年AMI合并AF患者AF控制率,明显改善了患者短期预后,且不良反应少,值得临床重视。     

地高辛与美托洛尔联合治疗房颤伴快速心室率的临床观察

目的探讨地高辛与美托洛尔合用治疗房颤伴快速心室率的临床效果。方法 96例房颤伴快速心室率患者随机分成观察组和对照组各48例,对照组予地高辛0.25mg,每日1次,5d后0.125mg,每日1次;观察组在地高辛用量的基础上予以初始剂量6.25mg·d^-1,逐渐加量至25-50mg·d^-1。结果两组治疗前运动最高心率、静息心率无显著性差异（P〉0.05）,对照组在治疗后的运动最高心率、静息心率均低于对照组（P〈0.05）,观察组临床效果优于对照组（P〈0.05）。未出现心衰加重,肝、肾功能无恶化,电解质正常。结论美托洛尔与地高辛联用房颤伴快速心室率,效果理想,可以作为控制持续性房颤心室率的首选药物之一。     

静脉应用胺碘酮治疗CHF伴快速心房纤颤(AF)患者的短时疗效

目的探讨静脉应用胺碘酮治疗充血性心力衰竭(CHF)伴快速心房纤颤(AF)患者的短时疗效。方法选取2013年12月至2016年12月于我院就诊的CHF伴快速AF患者共80例,心功能Ⅱ~Ⅳ级(NYHA),将患者按照入院编号,随机分为胺碘酮组与毛花苷两组,每组各40例。胺碘酮组患者在常规治疗基础上给予静脉应用胺碘酮治疗,毛花苷组患者在常规治疗基础上,给予静脉应用去乙酰毛花苷治疗。比较两组患者用药后的心室率变化、药物平均起效时间。结果两组患者用药后心室率均明显下降,与用药前比较均具有统计学差异,用药2 h后胺碘酮组心室率下降幅度显著大于毛花苷组(P<0.05);胺碘酮组的平均起效时间明显低于毛花苷组,数据符合统计学差异(P<0.05)。结论静脉应用胺碘酮治疗充血性心力衰竭(CHF)伴快速心房纤颤(AF)患者的短时疗效满意,患者安全性好,值得临床推广使用。     

米力农治疗慢性充血性心力衰竭急性加重期的临床观察

目的:观察米力农治疗慢性充血性心力衰竭(CCHF)急性加重期的临床疗效和安全性。方法:将100例CCHF急性加重期患者随机均分为对照组和观察组。对照组患者给予血管紧张素转化酶抑制剂、β受体阻滞药、利尿药、醛固酮受体拮抗药、洋地黄等常规治疗。观察组患者在对照组治疗的基础上给予米力农0.3 mg/kg加入5%葡萄糖液注射液50 ml中,微量泵持续泵入,qd。两组患者疗程均为5 d。观察两组患者的临床疗效,治疗前后心脏指数(CI)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、心胸比率(CTR)、氨基末端B型利钠肽前体(NT-pro BNP)含量及不良反应发生情况。结果:两组患者总有效率比较差异无统计学意义(P>0.05)。治疗后,两组患者LVEDD、CTR均显著低于同组治疗前,差异均有统计学意义(P<0.01),但两组间比较差异无统计学意义(P>0.05);CI、LVEF均显著高于同组治疗前(P<0.01),且观察组高于对照组(P<0.05);NT-pro BNP显著低于同组治疗前(P<0.01),且观察组低于对照组(P<0.05)。两组患者治疗期间均未见明显不良反应发生。结论:米力农治疗CCHF急性加重期的疗效和安全性与常规治疗相当,但在改善心功能方面优于常规治疗。     

观察左心室脱血回注循环辅助法对急性心肌梗死血流动力学的改善作用

目的观察分析左心室脱血回注循环辅助法对急性心肌梗死血流动力学的改善作用。方法选取我院2014年1月至2015年8月期间收治的82例急性心肌梗死患者予以研究,根据1∶1的方法分为2组:观察组(n=41)、对照组(n=41)。观察组患者行左心室脱血回注循环辅助治疗,对照组患者不予循环辅助治疗,对2组患者的临床治疗效果予以观察比较。结果观察组患者的心室纤颤、室性期外收缩发生率与病死率明显低于对照组(P<0.05)。在45 min后各时段,观察组患者外周动脉收缩压明显高于对照组(P<0.05);观察组患者左心室舒张末期压(LVEDP)、肺动脉毛细血管楔嵌压(PCWP)明显低于对照组(P<0.05)。结论在急性心肌梗死的治疗中,应用左心室脱血回注循环辅助法可以显著降低心室纤颤、室性期外收缩发生率与病死率,改善血流动力学,是一种值得临床选用与普及的治疗方法。     

艾司西酞普兰治疗慢性心力衰竭合并抑郁伴或不伴焦虑的临床观察

目的:观察艾司西酞普兰治疗慢性心力衰竭(CHF)合并抑郁伴或不伴焦虑的临床疗效和安全性。方法:将50例CHF合并抑郁伴或不伴焦虑患者随机均分为对照组和观察组。对照组患者给予原发病治疗、去除CHF诱因、限制饮食、口服CHF治疗药物等常规治疗;观察组患者在对照组治疗的基础上给予艾司西酞普兰片10 mg,口服,每日1次。两组患者疗程均为6个月。观察两组患者的临床疗效、治疗前后抑郁自评量表(SDS)评分、汉密尔顿抑郁量表(HAMD)评分、左心室射血分数(LVEF)、左心室短径缩短率(FS)及不良反应发生情况。结果:治疗后观察组患者总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者SDS评分、HAMD评分均显著低于同组治疗前,且观察组低于对照组;LVEF、FS均显著高于同组治疗前,且观察组高于对照组(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:艾司西酞普兰可有效改善CHF合并抑郁伴或不伴焦虑患者的抑郁症状,提高心功能,且安全性较好。     

老年人快速心房颤动有关室率控制的药物治疗

目的通过临床药物治疗症状轻微的老年心房颤动患者,通过临床效果观察进一步筛选有利方案,控制或缓解病情。方法急性期快室率的控制方法有目标心室率,无禁忌证者可给予静脉注射艾司洛尔或地尔硫卓控制心室率,伴心力衰竭或左室功能下降者,可静脉注射西地兰或胺碘酮控制心室率;AF伴预激综合征者首先胺碘酮或普罗帕酮。长期维持心室率控制方法有无禁忌证者首选β受体阻滞剂;合并心力衰竭者可服用地戈辛及β受体阻滞剂;心室率控制不满意者可用地戈辛与β受体阻滞剂或NOHPCCB联合治疗;地戈辛不单独用于非心力衰竭阵发性AF患者的心室率控制,AF伴预激史者可用普罗帕酮或胺碘酮。结果钙通道拮抗剂如维拉帕米和地尔硫卓可有效用于房颤时的心室率控制,对于运动状态下的心室率的控制优于地高辛,和地高辛合用的效果也优于单独使用,最常用于无器质性心脏病或左室收缩功能正常以及伴有慢性阻塞性肺疾病的患者。洋地黄类最适用于在紧急情况下控制房颤心室率的一线用药。结论β受体阻滞剂是最有效、最常用和常常单独应用的药物。临床上房颤治疗应个体化,症状轻微的老年心房颤动患者首选室率控制治疗,抗心律失常药物禁忌或不适宜转复的患者,亦应采用室率控制治疗。     

美托洛尔静脉注射治疗快速心房颤动临床研究

目的:观察美托洛尔注射液治疗快速心房颤动的疗效及安全性.方法:68例快速心房颤动患者随机分为试验组与对照组,试验组34例予美托洛尔注射液5～15 mg静脉注射,对照组34例予西地兰注射液0.4～0.8 mg静脉注射,分别观察治疗前及治疗后20,40,60,120 min患者心率及血压的变化.结果:两组患者分别有19例和13例在120 min内心室率降至<100次·min-1,两组比较差异无显著性(55.88%vs38.23%,P>0.05).两组心室率降至<100次·min-1所需时间分别为(18.33±12.31)和(65.00±35.05)min,两组比较差异有显著性(P<0.01).两组起效平均时间分别为(14.00±9.95)和(62.50±41.66)min(P<0.01).两组总有效率分别为85.29%和58.82%(P<0.01).结论:美托洛尔静脉注射治疗快速房颤安全有效,为急诊科快速安全治疗快速心房颤动的可靠方法.     

静脉注射美托洛尔对快室率房颤伴心衰的疗效观察

目的 探讨静脉注射美托洛尔对房颤快速心室率伴心衰的疗效及安全性.方法对房颤快室率伴心衰的患者经常规治疗,观测0.5h,如心率仍>100 beat·min-1,血压≥100/60 mmHg(1 mmHg=0.133 kPa)以上的患者,随机分三组,1组为美托洛尔注射液10 mg稀释后经微泵静注(微泵组)1h;2组为美托洛尔注射液5 mg,10 min缓慢静脉推注(推注组),观察10min,如心率仍大于100 beat·min-1,血压≥90/60mmHg则再重复给药一次;3组为生理盐水对照组.当心率≤60 beat.min-1.血压<90/60 mmHg时停止;各组静注药物前及开始给美托洛尔注射液或生理盐水后1h,观察症状、体征、心率、血压、肺部罗音、血流动力学和ANP、BNP等指标.结果静脉注射美托洛尔后大多数患者心衰症状、体征明显改善,心室率、BNP和ANP显著下降且比对照组明显,收缩压、舒张压有所降低但与对照组无显著差异,无创心功能参数中CO,SI,SV,LVET显著增加并且比对照组明显.结论 美托洛尔静脉注射治疗快室率房颤伴心衰是有效和安全的.     

艾司洛尔与洋地黄控制房颤心室率的疗效比较分析

比较静注艾司洛尔和洋地黄对房颤的疗效。结果:静注艾司洛尔组(40例)起效快(0～5 min),有效率高(92.5%),副作用发生率低(2.5%),静息和运动时心室率减慢。口服洋地黄组(40例)起效慢(20～30 min),有效率低(75.0%),副作用发生率高(15%)。     

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。     

急诊老年心房颤动快速心室率患者临床用药效果观察

摘要 目的：观察并比较静脉注射毛花甙C、地尔硫卓及胺碘酮控制老年房颤伴快速心室率的有效性和安全性。方法：收集于天津医科大学第二医院心脏科急诊诊治的心房颤动伴快速心室率的老年患者(≥60岁)97例,患者随机分为3组,分别静脉用毛花甙C(A组,30例)组、地尔硫卓(B组,32例)和胺碘酮(C组,35例)组。观察用药前及用药后5、l0、15、30、60、90min患者的心室率、血压、心律变化以及药物起效时间及不良反应。结果：毛花甙C、地尔硫卓和胺碘酮均能有效控制心房纤颤伴快速心室率患者的心室率。总有效率分别为75％、90％和85％,平均用药有效时间分别为(35.4±15.7)min、(9.7±3.6) min和(18.8±7.6)min。西地兰组恢复窦律6例,低血压l例;地尔硫卓组恢复窦律5例,出现低血压2例,窦缓l例;胺碘酮组恢复窦律8例,窦缓l例;均自行缓解,未发生心衰加重。结论：毛花甙C、地尔硫卓及胺碘酮均能有效、迅速、安全控制老年房颤伴快速心室率患者的心室率。但地尔硫卓、胺碘酮更迅速,而胺碘酮相对安全。     

The safety of digoxin as a pharmacological treatment of atrial fibrillation

Digoxin has traditionally been the drug of choice for ventricular rate control in patients with chronic atrial fibrillation (AF), with or without heart failure (HF) with systolic dysfunction. In patients with permanent AF, digoxin monotherapy is ineffective to control ventricular rate during exercise, but the combination of digoxin with a β-blocker or a non-dihydropyridine calcium channel antagonist can control heart rate both at rest and during exercise. Only a few randomised, controlled studies have evaluated the adverse effects of digoxin in patients with AF in a systematic way and side effects requiring drug withdrawal have rarely been reported. When reported, the most frequent adverse effects were cardiac arrhythmias (ventricular arrhythmias, AV block of varying degrees and sinus pauses). This evidence suggested that, in contrast to other antiarrhythmic drugs, digoxin is a safe drug in patients with AF. However, this safety profile can be erroneous due to the short follow-up of the studies and patient selection. Because patients with HF have been excluded in most studies, the safety profile of digoxin in this population has not been directly addressed. Early recognition that an arrhythmia is related to digoxin intoxication as well as recognition of concomitant medications or medical conditions that may directly alter the pharmacokinetic profile of digoxin, or indirectly alter its cardiac effects by pharmacodynamic interactions remain essential for safe and effective use of digoxin in patients with AF.     

The safety of digoxin as a pharmacological treatment of atrial fibrillation

Digoxin has traditionally been the drug of choice for ventricular rate control in patients with chronic atrial fibrillation (AF), with or without heart failure (HF) with systolic dysfunction. In patients with permanent AF, digoxin monotherapy is ineffective to control ventricular rate during exercise, but the combination of digoxin with a beta-blocker or a non-dihydropyridine calcium channel antagonist can control heart rate both at rest and during exercise. Only a few randomised, controlled studies have evaluated the adverse effects of digoxin in patients with AF in a systematic way and side effects requiring drug withdrawal have rarely been reported. When reported, the most frequent adverse effects were cardiac arrhythmias (ventricular arrhythmias, AV block of varying degrees and sinus pauses). This evidence suggested that, in contrast to other antiarrhythmic drugs, digoxin is a safe drug in patients with AF. However, this safety profile can be erroneous due to the short follow-up of the studies and patient selection. Because patients with HF have been excluded in most studies, the safety profile of digoxin in this population has not been directly addressed. Early recognition that an arrhythmia is related to digoxin intoxication as well as recognition of concomitant medications or medical conditions that may directly alter the pharmacokinetic profile of digoxin, or indirectly alter its cardiac effects by pharmacodynamic interactions remain essential for safe and effective use of digoxin in patients with AF.     

硫氮唑酮治疗肺源性心脏病并发心房纤颤的疗效观察

目的 :观察硫氮唑酮治疗肺源性心脏病 (肺心病 )并发房颤的临床疗效及安全性。方法 :选择肺心病合并房颤患者78例 ,随机分为硫氮唑酮治疗组 (38例 )和地高辛治疗组 (40例 ) ,一般治疗相同 ,2周后观察心室率的变化情况。结果 :硫氮唑酮控制心室率的疗效明显强于地高辛 (P<0 01)。结论 :硫氮唑酮能够有效地控制肺心病并发房颤患者较快的心室率 ,改善患者的临床症状、心功能及心电图。并且其安全性高 ,是治疗肺心病患者心房纤颤的有效途径。     

扩张型心肌病应用曲美他嗪治疗临床观察

目的观察应用曲美他嗪治疗扩张型心肌病并慢性充血性心力衰竭临床疗效。方法选取近年来我院扩张型心肌病并慢性充血性心力衰竭患者46例,随机分成治疗组和对照组,两组均为23例,对照组给予利尿剂、洋地黄、单硝酸脂类药物、血管紧张素酶抑制剂和β受体阻滞剂。治疗组在对照组基础上加用曲美他嗪每天3次,一次20 mg,观察6个月。观察治疗前后心功能分级变化、左室射血分数(LVEF),心衰加重再住院率。结果曲美他嗪组治疗后的心功能改善比对照组明显LVEF与对照组相比有明显提高,再住院明显减少。结论曲美他嗪能显著改善扩张型心肌病心功能。     

Atrial fibrillation

In 2000, some 2.3 million Americans were affected by atrial fibrillation, and that number is expected to rise as our population ages. Atrial fibrillation is both a reflection of active physiologic stressors on the body and a marker of future cardiac disease progression. The disorganized atrial activity that characterizes atrial fibrillation affects cardiac function, metabolic demand, and quality of life. However, our understanding of the etiology and treatment of this condition continues to advance with the result of recent large-scale clinical trials. Diabetes, hypertension, congestive heart failure, valvular disease, and myocardial infarction are all risk factors in the development of atrial fibrillation. And the diagnosis confers a five-fold increase in the incidence of stroke. (Patients at increased risk for stroke include those with congestive heart failure, hypertension, age greater than 75, diabetes, and previous stroke.) Anticoagulation is a critical action in most cases of atrial fibrillation, as data show a 68% relative risk reduction of stroke when patients are treated with warfarin. Prior to recent trials, achieving sinus rhythm was thought to invariably improve symptoms, cardiac function, and mortality. The adverse effects of antiarrhythmic medications are now being recognized, and treatment strategies emphasizing ventricular rate control have been recommended in recent clinical practice guidelines. This shift in thinking is influencing both outpatient and emergency department management. Controlling the ventricular rate in atrial fibrillation increases cardiac output, decreases the metabolic demand of the heart, and avoids the potentially dangerous side effects of rhythm-control drugs. Rate-control agents should be selected based on the clinical profile of individual patients. A well-chosen subset of patients may benefit from either chemical or electrical cardioversion; this appears to be a reasonably safe procedure and can be accomplished on an outpatient basis. Understanding causal etiologies, managing risk for stroke (and need for anticoagulation), addressing rate, and assessing the risks of cardioversion are key elements in a comprehensive approach to atrial fibrillation.     

慢性心衰患者发生房颤的多因素分析

目的通过回顾性分析慢性心衰患者的临床资料,对慢性心衰患者发生房颤的因素进行分析。方法选择2009年1月至2011年1月期间该院心脏科收治的慢性心力衰竭（NYHAII-IV）患者330例,根据患者是否发生心房颤动（AF）将其分为AF组与非AF组两组,并对两组患者的临床资料进行统计分析。结果 330慢性心力衰竭患者中共发生房颤85例（25.76%）为AF组,其余245例未发生房颤者则为非AF组。单因素COX回归分析表明患者重度心衰（III＋IV级别）、年龄、糖尿病、左室肥厚、左房直径、尿素氮、血肌酐、血尿酸、安体舒通为房颤发生的危险因素。而ACEI、洋地黄、血钠、血氯为房颤发生的保护因素。Logistic回归分析表明ACEI为心力衰竭患者初发AF的独立保护因素,重度心衰、左心室肥厚左心房直径则为AF发生的危险因素。结论重度心衰、左心室肥厚左心房直径则为AF发生的危险因素;ACEI为心力衰竭患者初发AF的独立保护因素,其能降低AF的发生。     

Oral loading with propafenone for conversion of recent-onset atrial fibrillation: a review on in-hospital treatment

Atrial fibrillation (AF) is a very common arrhythmia. In order to treat acute AF rapidly, effective drug regimens are required. Propafenone is a class IC antiarrhythmic agent that is suitable for oral loading as it reaches peak plasma concentrations within 2 to 4 hours of administration. The use of propafenone loading in patients with AF must be based on appropriate patient selection in view of the negative inotropic effect and the potential proarrhythmic effects of the drug. A series of controlled trials in patients with recent-onset AF without heart failure who were hospitalised with enforced bed rest has shown that orally loaded propafenone (450 to 600 mg as single dose) exerts a relatively quick effect (within 3 to 4 hours) and a high rate of efficacy (72 to 78% within 8 hours). A potentially harmful effect of class IC agents is the risk of transforming AF into atrial flutter (3.5 to 5% of patients). However, atrial flutter with 1 : 1 atrioventricular response was observed in only two of 709 patients receiving propafenone (0.3% incidence). Nevertheless, the potential negative inotropic effect of propafenone demands careful patient selection, with systematic exclusion of patients with left ventricular dysfunction or congestive heart failure. Oral loading with propafenone can be considered as an episodic treatment in patients with AF recurrences, as has been proposed for other drugs in the past. However, the safety of oral loading with propafenone as an outpatient treatment in appropriately selected patients has to be assessed by appropriately designed prospective studies.