艾司洛尔、胺碘酮和地尔硫(艹卓)治疗麻醉期间快室率心房颤动的比较

目的 观察静脉注射艾司洛尔、胺碘酮和地尔硫革治疗麻醉期间快室率心房颤动(房颤)的有效性和安全性.方法 将90例快室率房颤患者随机分为艾司洛尔组(Ⅰ组)、胺碘酮组(Ⅱ组)和地尔硫革组(Ⅲ组).Ⅰ组先以艾司洛尔0.5 mg/kg负荷量于1 min内静脉注射,继之以0.05mg·kg-1·min-1静脉泵注射;Ⅱ组以胺碘酮3 mg/kg于10 min内静脉注射,继之以1 mg/min静脉泵注射;Ⅲ组以地尔硫革0.25 mg/kg于5 min内静脉注射.观察用药前及用药后5、10、15、30、60、90min患者的心室率、血压、心律;观察起效时间及不良反应.结果 起效时间Ⅰ、Ⅱ、Ⅲ组分别为(4.3±2.1)min、(19.2±8.5)min、(8.5±3.4)min,组间比较差异均有统计学意义(P＜0.05);有效率在用药后30 min内组间比较差异有统计学意义(P＜0.05),但总有效率(用药后90 min时)三组组间比较差异均无统计学意义(P＞0.05).总不良反应发生率Ⅱ组低于Ⅰ组、Ⅲ组(P＜0.05),Ⅰ组与Ⅲ组组间比较差异无统计学意义(P＞0.05).结论 艾司洛尔、胺碘酮和地尔硫革均可安全有效地治疗麻醉期间的快室率房颤,艾司洛尔起效最迅速,胺碘酮应用最安全.

A comparative study on the efficacy and safety of intravenous esmolol, amiodarone and diltiazem for controlling rapid ventricular rate of patients with atrial fibrillation during anesthesia period

Objective To evaluate the efficacy and safety of intravenous esmolol, amiodarone and diltiazem for controlling rapid ventricular rate in patients with atrial fibrillation (AF) during anesthesia period. Methods Ninety AF patients with rapid atrial ventricular rate ( ≥ 120 beats/min) in anesthesia period were randomly divided into 3 groups ( n = 30 each: group Ⅰ patients were treated with intravenous group Ⅱ patients were treated with intravenous amiodarone (loading dose: 3 mg/kg for 10 minutes, followed with intravenous infusion of 1 mg/min); group Ⅲ patients were treated with intravenous diltiazem ( 0. 25 mg/kg for 5 minutes). The heart rate, blood pressure, rhythm were recorded before treatment, at 5, 10,15, 30, 60 and 90 min after treatment. The reacting time, side effects including hypotension, bradycardia,nausea, vomiting, dizziness, etc, were analyzed. Results The mean reacting time was significantly shorter in group Ⅰ (4.3 ±2. 1)min than in group Ⅱ (19.2 ±8.5) min and in group Ⅲ (8.5 ±3.4) min (P＜0. 05 ). The mean reacting time in group Ⅲ was significantly shorter than in group Ⅱ ( P ＜ 0. 05 ). The total effective rate were similar among the groups ( 86. 7%, 90.0% and 83.3% with a mean decrease in heart ventricular rate by 42.4%, 42% and 41.9% of the baseline level in group Ⅰ , group Ⅱ and group Ⅲ,respectively). The incidence of total side effect was significantly lower in group Ⅱ ( 10% ) than in group Ⅰ ( 16. 7% ) and group Ⅲ (20%, P ＜ 0. 05). Conclusions Intravenous esmolol, amiodarone and diltiazem are all equally effective and safe on controlling rapid ventricular rate in patients with atrial fibrillation during the anesthesia period. Esmolol use is associated with the shortest mean reacting time and amiodaron use is associated with the lowest total side effect rate in this patient cohort.