42例心脏手术后新发快速心房颤动的治疗体会

【摘要】 目的 总结42例心脏手术后新发快速心房颤动的治疗经验。方法 2002年8月至2012年8月,我科施行的395例术前为窦性心律的心脏手术患者中,有42例患者术后新发快速心房颤动,其中冠心病18例,心脏瓣膜病15例,冠心病合并心脏瓣膜病3例,先天性心脏病6例。患者术后新发快速房颤时,在心电监护下静脉使用胺碘酮,首先控制心室率,争取转复为窦性心律,并行抗凝治疗,同时口服胺碘酮治疗。术中安置了临时起搏导线的患者,术后开启临时起搏器,设置保护心率70~90次/分。房颤发作前已使用β受体阻滞剂的患者,不停用。结果 24小时内有32例患者转为窦性心律,其余患者5天内转复为窦性心律。无死亡病例,无脑梗塞病例发生。结论 采用胺碘酮,可将心脏术后新发的心房颤动转复为窦性心律;胺碘酮与β受体阻滞剂合用时,要注意调整好两者的用量,避免心率过慢的发生,同时要注重房颤诱因的治疗。

Expericece in the treatment of for new onset rapid atrial fibrillation following cardiac surgery in 42 cases

Yu Xiaoli, Zhang Dongcheng, Lin Qinwen, Yu Tao, Qin Xianyu. Department of Cardiac Surgery, The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou 510260
Objective To summarize the experiences of management for new onset rapid atrial fibrillation （AF） following cardiac surgery in 42 cases. Methods From August 2002 to August 2012, 395 patients with sinus rhythm underwent cardiac operations ,.in which 42 patients developed new onset rapid AF following cardiac surgeries including 18 cases of coronary heart disease ,.15 cases of valvular heart disease,.3 cases of coronary heart disease combined with valular heart disease ,.and 6 cases of congenital heart disease..These patients were treated with amiodarone both intravenously and orally under ECG monitoring and controled heart rate in a normal level at first and converted sinus rhythm positively along with anticoagulant therapy..Temporary pacemakers were placed during operations to set up a protective heart rate of 70 to 90 bpm..Those who administrated with β-blocker before operations continued its use. Results Normal sinus rhythm was restored in 32 patients within 24 hours and the others in the following four days..No cerebral infarction or death occurred. Conclusion The administration of amiodarone promotes the conversion to normal sinus rhythm from post-operative AF. . Cautious adjustment of the dose should be made in the combined use of amiodarone and β-blocker in order to prevent bradycardia..The importance of the treatment for precipitating causes of AF should not be overlooked at the meantime.