CAJ | 학술논문

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,600 mg/d(200mg tid),连续7d,之后改为200 mg/d至术前,术后当天开始静脉滴注胺碘酮,负荷量为5 mg/kg,之后给予维持量0.5 mg· kg-1 ·h-1,能进食后改为200 mg/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.
목적 탐토위수술기응용알전동재예방비체외순배하심장불정도관상동맥탑교술후방전중적작용.방법 채용수궤대조적연구방법,장2009년1월지2011년1월재아과진행비체외순배하심장불정도관상동맥탑교술적환자수궤분위시험조화대조조,매조각100례.A조위시험조,술전구복알전동,600 mg/d(200mg tid),련속7d,지후개위200 mg/d지술전,술후당천개시정맥적주알전동,부하량위5 mg/kg,지후급여유지량0.5 mg· kg-1 ·h-1,능진식후개위200 mg/d구복.B조위대조조,불급여알전동치료이부용상규약물.관찰량조환자술후방전발생솔급심솔변화,동시검측시험조환자술전급술후제2천적알전동혈약농도.결과 량조환자적술전일반특정급수술정황상근.시험조100례환자중술후유10례(10.0％)발생방전,대조조100례환자중유36례(36.0％)발생방전(P=0.015).시험조방전시최대심실솔위(126.0±20.8)차/min,방전지속시간위1.0d,대조조방전시최대심실솔위(150.0±25.6)차/min,방전지속시간위(3.0±1.5)d(P＜0.05).시험조술후심솔만우대조조,량조Q-T간기、술후병발증적발생급사망솔무통계학차이.시험조적주원시간위(10.6±2.8)d,대조조주원시간위(15.4±3.2)d(P ＜0.05).알전동혈약농도평균치술전위(797±136)ng/ml,술후제2천위(763±94) ng/ml(P ＞0.05).결론 알전동재예방비체외순배하심장불정도관상동맥탑교술후방전중적작용현저,능안전유효지강저술후방전적발생솔,축단방전지속시간,차무명현불량반응.
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 offpump 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.