急诊静脉注射胺碘酮转复阵发性房颤疗效和安全性观察

目的观察急诊静脉注射胺碘酮转复阵发性房颤的疗效及安全性。方法 215例发生于48h内的急诊阵发性房颤患者,随机分为胺碘酮治疗组（治疗组,106例）和普罗帕酮治疗组（对照组,109例）。治疗组首次静脉注射胺碘酮150mg,如未能复律,30min后再次静脉推注150mg,仍未复律则用微量输液泵以0.5～1mg.min-1剂量持续输注,直至复律或无效终止;对照组则静注普罗帕酮（70mg/次）1～2次（根据治疗反应）,未能复律时用微量输液泵以0.5～1mg.min-1剂量维持,直至复律或无效终止。观察并记录患者心脏节律、心室率、血压变化及不良反应。结果两组总转复率无显著性差异（80.19%/74.31%）,但对照组第一次用药转复率显著高于治疗组（45.87%/29.24%）,维持用药治疗组显著高于对照组（23.58%/10.09%）。治疗组常见的不良反应为心动过缓、长间歇、低血压、面部潮红和全身皮肤灼热感;对照组常见不良反应为心功能不全、窦性心动过缓、低血压和房室传导阻滞。结论静脉注射胺碘酮治疗阵发性房颤转复率较高,且较安全,值得在急诊科推广应用。

Efficacy and safety of intravenous amiodarone for conversion of paroxysmal atrial fibrillation in emergency department

OBJECTIVE To evaluate the efficacy and safety of intravenous amiodarone for conversion of paroxysmal atrial fibrillation(AF) in emergency department.METHODS 215 patients with paroxysmal AF(onset within 48 hours) were divided into two groups randomly,the treatment group(n=106) and the control group(n=109).Patients in the treatment group received amiodarone 150mg IV over 10min,treatment was repeated if AF was not converted 10 minutes after the first dosage,and then if AF persisted ten minutes later,0.5～1.0mg·min-1 amiodarone administered by continuous infusion with microsyringe pump until success or unsuccess in 24h.Patients in the control group received propafenone 70mg IV over 10min,followed by a further 70mg if AF persisted 10 min after the first dosage,and then 0.5～1.0mg·min-1 propafenone by continuous infusion until success or unsuccess.Conversion characteristics and adverse reactions were recorded.RESULTS There were no significant difference between the total rate of cardioversion of two groups(80.19% VS 74.31%),but during the first dosage the rate of cardioversion of the control group was significant higher than that of the treatment group(45.87% VS 29.24%),during continuous infusion the rate of the treatment group was significant higher than the control’s.The common adverse reactions of the treatment group were bradycardia,long pause,hypotension,face aestus and burning sensation of skin.Heart failure,bradycardia,hypotension and atrial ventricular block was common adverse reactions in the control group.CONCLUSIONS In the emergency department,intravenous amiodarone can convert paroxysmal AF successfully and safety,and worth to use.