围术期应用胺碘酮预防心脏不停跳冠状动脉搭桥术后房颤的研究

目的探讨围手术期应用胺碘酮在预防非体外循环下心脏不停跳冠状动脉搭桥术后房颤中的作用。方法采用随机对照的研究方法,将2009年1月至2011年1月在我科进行非体外循环下心脏不停跳冠状动脉搭桥术的患者随机分为试验组和对照组,每组各100例。A组为试验组,术前口服胺碘酮,600mg/d(200mgtid),连续7d,之后改为200mg/d至术前,术后当天开始静脉滴注胺碘酮,负荷量为5mg/kg,之后给予维持量0.5mg.kg-1.h-1,能进食后改为200mg/d口服。B组为对照组,不给予胺碘酮治疗而仅用常规药物。观察两组患者术后房颤发生率及心率变化,同时检测试验组患者术前及术后第2天的胺碘酮血药浓度。结果两组患者的术前一般特征及手术情况相近。试验组100例患者中术后有10例(10.0%)发生房颤,对照组100例患者中有36例(36.0%)发生房颤(P=0.015)。试验组房颤时最大心室率为(126.0±20.8)次/min,房颤持续时间为1.0d,对照组房颤时最大心室率为(150.0±25.6)次/min,房颤持续时间为(3.0±1.5)d(P<0.05)。试验组术后心率慢于对照组,两组Q-T间期、术后并发症的发生及死亡率无统计学差异。试验组的住院时间为(10.6±2.8)d,对照组住院时间为(15.4±3.2)d(P<0.05)。胺碘酮血药浓度平均值术前为(797±136)ng/ml,术后第2天为(763±94)ng/ml(P>0.05)。结论胺碘酮在预防非体外循环下心脏不停跳冠状动脉搭桥术后房颤中的作用显著,能安全有效地降低术后房颤的发生率,缩短房颤持续时间,且无明显不良反应。

Using amiodarone perioperatively prophylaxis for atrial fibrillation before and after off-pump coronary artery bypass grafting

Objective To evaluate the effect of administered low-dose amiodarone on the incidence of postoperative AF before and after off-pump beating-heart coronary artery bypass graft.Methods In this study,200 patients who had undergone coronary artery surgery were randomly divided into two groups.Amiodarone group(n=100)was given oral amiodarone in a dose of 200 mg three times per day for 7 days,the 200 mg per day until the operation day,and intravenous amiodarone in a loading dose of 5 mg/kg and maintenance dose of 0.5 mg·kg-1·h-1 on the operation day.The incidence of AF and heart rate in this group was assessed and compared with the control group(n=100).The amiodarone plasma concentration was measured before and 2 days after operation.Results There were no significant differences among patient characteristics and types of operative procedures between patients in both groups.Postoperative atrial fibrillation occurred in 10 of 100 patients in the amiodarone group(10.0%)and 36 of 100 patients in the control group(36.0%)(P=0.015).The maximal ventricular rate during AF in the amiodarone group was(126.0±20.8)bpm and the duration of AF was(8.0±8.6)h,which were significantly lower than in the control group(150.0±25.6)bpm,(12.0±9.6)h,P<0.05].The hospitalization time of the patients in the amiodarone group were fewer than in the control group(10.6±2.8)d,(15.4±3.2)d,P<0.05].The amiodarone plasma concentration averaged(797±136)ng/ml before operation and(763±94)ng/ml in the 2 days after operation(P<0.01).Conclusions Using amiodarone perioperatively in patients undergoing off-pump cardiac coronary artery bypass grafting surgery is well tolerated and significantly reduces the incidence of postoperative atrial fibrillation and the duration of hospitalization with low adverse effects.