口服胺碘酮治疗非瓣膜病阵发性心房颤动的疗效及安全性

探讨口服胺碘酮治疗非瓣膜病阵发性心房颤动(简称房颤)的疗性和安全性,选取64例非瓣膜病阵发性房颤为随访观察对象。给药方法:负荷量,第一周每天0.6g,第二周每天0.4g,维持量每天0.1~0.2g。结果:随访1.7±1.6年。有效52例(81.3%),复发7例(13.5%)。22例出现不良反应(34.4%)。多因素Logistic回归分析显示:房颤发作时间和诱因、以及是否应用血管紧张素转换酶抑制剂(ACEI)或紧张素受体拮抗剂(ARB)为影响胺碘酮治疗阵发性房颤疗效的独立预测因素,胺碘酮对于白天发作、且与劳累或生气等因素有关的阵发性房颤疗效较高(OR6.22,P=0.05),服用ACEI或ARB可能有助于阵发性房颤的治疗(OR21.65,P=0.03)。甲状腺功能异常9例(14.1%),心率减慢8例(12.5%),恶心、厌食2例,光过敏1例,皮疹1例,复视1例,嗜睡1例,咳嗽及肺部阴影各1例。结论:①胺碘酮治疗非瓣膜病阵发性房颤疗效较高、相对安全;②胺碘酮对于多于白天发作、且与劳累或生气等因素有关的阵发性房颤疗效较高;③ACEI或ARB可能有助于阵发性房颤的治疗。

The Efficacy and Safety of Oral Amiodarone Therapy in Patients With Nonvalvular Paroxysmal Atrial Fibrillation

To investigate the efficacy and safety of oral amiodarone therapy in patients with nonvalvular paroxysmal atrial fibrillation(PAF), sixty four consecutive patients with nonvalvular PAF were followed up after amio darone was orally administered. Usage of amiodarone: A loading dose was given within two we eks as follows, 0.2g for three times a day during the first week and then 0.2g for two times a day during the second week . The maintenance dose(0.1-0.2g for one time a day)was adm inistered from the third week. Results: The mean duration of follow-up was 1.7±1.6 years. 52 case s(81.3%)were effective,among which 7 cases(13.5%)recurred. Multivariate Logistic regression analysis showed the episode time and inducing factors of PAF and using of angiot ensin converting enzyme inhibiting (ACEI) or angiotensin receptor blocker(ARB) were the independe nt determinants of amiodarone efficacy in patients with nonvalvular PAF. The efficacy of amiodarone was better(OR 6.22, P=0.05)in patients with nonvalvuar PAF which ma inly occurred during day-time and caused by tiredness or strong emotion than in patients with PAF ma inly occurred during night-time , rest or post dinner and it was also better in patients who took ACEI or ARB frequently(OR 21.65, P=0.03)compared with those who did not take these dru gs.Side effects were identified in 22 cases (34.4%).Among them, there were 9 cases(14.1%) with abnormal T_3 or T_4, 8 cases(12.5%) with slower heart rate , two cases with nausea and anorexia, one case with aller gic reaction to sun light, one case with rash , one case with blurred vision , one case with sleepin ess, one case with cough and one case with local blurred lung area on x-rays. Conclusions: Amiodarone is highly effective and relatively safe for treatment of nonvalvular PAF. The efficacy of amiodarone is better in patients with nonvalvuar PAF which mainly oc curred during day-time and caused by tiredness or strong emotion. ACEI and ARB is helpful to control nonvalvuar PAF when treated by amiodarone.