胺碘酮治疗急性冠状动脉综合征并发快速心房颤动的疗效观察

目的:观察静脉应用胺碘酮治疗急性冠状动脉综合征(ACS)并发快速心房颤动(AF)的临床疗效及安全性.方法:对48例ACS伴新近发生快速AF的患者,先静脉注射胺碘酮150 mg,随后以0.5～1.0 mg/min静脉滴注维持0.5～24 h,观察治疗后30 min、2 h、24 h时AF转复、心室率控制、血压变化、心功能与复律情况及药物不良反应.结果:用药后36例AF转复为窦性心律,转复率75.0%;用药后心室率明显下降,与治疗前差异均有统计学意义(P<0.01);治疗前后收缩压变化不明显(P>0.05),但用药后不同时间的舒张压均低于用药前(P<0.01).心功能Ⅰ、Ⅱ级的ACS患者复律率(82.9%)高于心功能Ⅲ、Ⅳ级组复律率(46.2%)(P<0.05).出现窦性心动过缓5例(10.4%),减量或停药后恢复正常;血压偏低4例(8.3%),予多巴胺升压后恢复正常.结论:静脉注射胺碘酮对ACS并发快速AF转复率较高,不良反应较少.

Effects of treatment for acute coronary syndrome with fast atrial fibrillation with amiodarone

Objective:To observe the effects and safety of intravenous injection amiodarone on acute coronary syndrome(ACS) with fast atrial fibrillation(AF).Methods:Forty-eight cases with ACS with fast AF were treated with intravenous injection of amiodarone,and maintained at 0.5-1.0 mg/min for 0.5-24 hours.The reversion of AF,the ventricular rates,blood pressure and side-effects were observed at 30 min,2 hour and 24 hour after treatment.Results:Compared with pretreatment,36 cases were reverted(the reversion rates as 75%) and the ventricular rates were apparent decline after treatment(P<0.01).Systolic blood pressure change was not apparent,but the diastolic blood pressure after treatment was lower than that of pre-treatment(P<0.05),The reversion rates of cardiac function with grade Ⅰ and Ⅱ(82.9%) were higher than that of cardiac function with grade Ⅲ and Ⅳ(46.2%)(P<0.05).Five cases(10.4%) with sinus bradycardia and 4 cases(8.3%) with low blood pressure after reduction or stopping the drug,which could recover after giving dopamine were observed.Conclusions:Treatment of ACS with fast AF with intravenous injection of amiodarone have higher reversion rates and fewer side-effects.