地尔硫(艹卓)与西地兰-D对心房颤动心室率的控制及其对房室传导的影响

目的:比较地尔硫革(Diltiazem)及西地兰-D对心房颤动(房颤)心室率控制的安全性和有效率以及对传导系统的影响。方法:对43例房颤患者随机地接受0.4mg西地兰-D(n-22)或0.25mg/kg地尔硫(?)(n=21)。120 min时无效者重复同剂量地尔硫(?)或0.2 mg西地兰-D。记录用药前后5、10、20、30、60 min的心室率及血压。无效者观察120 min及第2次用药者180 min的心室率及血压。19例窦性心律患者随机分为西地兰-D(n=10)和地尔硫(?)(n=9)组行希氏束电图检查测量PA、AH、HV间期而评估西地兰-D及地尔硫(?)对传导系统的影响。记录药物注射前及注射后的5、10、20、30 min的希氏束电图。结果:地尔硫(?)及西地兰-D组中180min内能有效控制心室率分别为20及15例(95.2％:68.2％,P<0.05)。地尔硫(?)及西地兰-D均延长AH间期,但对PA、HV问期无影响。结论:地尔硫(?)及西地兰-D均能减慢房颤心室率,但地尔硫(?)的有效率、心室率下降幅度优于西地兰-D。地尔硫(?)对心室率快的房颤伴充血性心力衰竭患者是一种较为合适的药物,在密切监护下应是安全的。两药均不影响HV、PA间期而通过延长AH间期减慢心室率。

Comparison between diltiazem and cedilanid-D on ventricular rate control of atrial fibrillation and their effects on atrioventricular conduction

Objective:To compare the safety and efficacy of intravenous diltiazem versus intravenous cedilanid-D (deslanoside) for ventricular rate control in patients with atrial fibrillation (AF). Analysis of the effecs of these drugs on atrioventricular conduction was also performed. Methods:Forty three patients with AF were randomly assigned to receive intravenous therapy with 0. 25mg/kg diltiazem( n =21) or 0. 4 mg cedilanid-D( n =22). If not effective at 120 minutes another dose of diltiazem or 0. 2 mg cedilanid-D was administered. Blood pressure and electrocardiographic recordings were performed before and after 5, 10, 20, 30, 60 minutes of drug administration. Further recordings were performed at 120 minutes in non-effective patients, and at 180 minutes in patients who received second drug administration. To evaluate the effect on conduction system of these two drugs by measuring PA, AH and HV intervals using His bundle electrogram, another nineteen patients with sinus rhythm were randomized to diltiazem(n =9) and cedilanid-D(n=10) group. His bundle electrogram recordings were performed before and after 5, 10, 20 and 30 minutes of drug administration. Results:Diltiazem maintained effective ventricular rate in 20 patients, whereas cedilanid-D maintained in 15 patients within 180 minutes (95. 2%vs 68.2%, P < 0. 05). There were no statistical significance in baseline heart rate, age and weight between the two groups. Both diltiazem and cedilanid-D can increase AH interval, but have no effect on HV and PA intervals in sinus rhythm patients. Conclusion:Both diltiazem and cedilanid-D decrease ventricular heart rate, but heart rate reduction is significantly higher in diltiazem group, it should be considered as a drug of choice for emergency to control the ventricular rate. Under clinical monitoring this dose of diltiazem seems to be safe and applicable in AF patients with congestive heart failure. Both drugs have no effects on PA and HV intervals but increase the AH intervals thereby can reduce ventricular rate.