小剂量胺碘酮预防阵发性心房颤动发作临床探究.doc

小剂量胺碘酮预防阵发性心房颤动发作临床探究[摘要] 目的：探讨小剂量胺碘酮预防有明显临床症状的阵发性心房颤动复发的疗效。方法：作为研究对象的200例病人均具有由心房颤动引起的头晕、心悸、胸痛及呼吸困难等症状，有心房颤动的心电图记录，每次心房颤动发作能在48 h内自行终止而恢复窦性心律，且无明显的器质性心脏病引起的症状，左室射血分数＞40％，临床基础特征基本相似的。随机分成两组，每组各100人，采用双盲法对比观察。胺碘酮组：胺碘酮0.2 g，每日3次，口服，第4日起改为0.2 g，每日1次，维持180 d。安慰剂组：安慰剂0.2 g，每日3次，口服，第4天起改为0.2 g，每日1次，维持180 d。每月随防1次，用Kaplan-Meier方法估计维持窦性心律的百分比。结果：在6个月随防期内胺碘酮组病人心房颤动复发率为16％（16／100），而安慰剂组心房颤动复发率为87％（87／100，P=0.000）。结论：小剂量胺碘酮用作预防有明显症状的阵发性心房颤动发作安全有效。 [关键词] 心房颤动；胺碘酮 [中图分类号] R541.7+5[文献标识码]A [文章编号]1673-7210（2008）02（b）-015-02 Low-dose Amiodarone for suppression of recurrent symptomatic atrial fibrillation LI Wei, LI Feng-yun, CHENChen*, FENG Xiao-lan, LIN Wei，HUANG Zan-wei，QU Long (Department of Cardiology, Kexuecheng Hospital of Mianyang, Mianyang 621900，China) [Abstract] Objective: This study investigated the safety and efficacy of amiodarone in the treatment of patients with recurrent symptomatic atrial fibrillation.Methods:200 patients were entered into a randomized, double-blind study.Of these, 100 received amiodarone and the others placebo. There were no significant differences in baseline clinical characteristics between groups. Patients with ejection fraction 3 讨论 本研究通过设立安慰剂作为对照组，显示小剂量胺碘酮能较好地预防阵发性房颤复发，即小剂量胺碘酮能使84％阵发性房颤病人维持窦性心律达半年。有文献认为，胺碘酮具有明显的副作用[5, 6]，本研究显示，小剂量胺碘酮比较安全，所有观察病人均未发生明显的副作用。因此认为，小剂量胺碘酮预防阵发性房颤发作安全有效，值得临床推广。 [参考文献] [1]Coplen SE, Antman EM,Berlin JA,et al. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion[J]. Circulation, 1990, 82:1106-1116. [2]Reimold SC. Clinical challenge I: Control of recurrent symptomatic atrial fibrillation[J]. Eur Heart, 1996, 17( Suppl C): 35-40. [3]Nattel S. Newer developments in the management of atrial fibrillation[J]. Am Heart J, 1995, 130:1094-1106. [4]Chun SH, Sager PT, Stevenson WG, et al. Long-term efficacy of amiodarone for the maintenance of normal sinus rhythm in patients with refractory atrial fibrillation or flutter[J]. Am J Cardiol,