| | | | | 瓣膜置换术后心房颤动患者门诊药物复律的初步观察 | | | 钱永军;肖锡俊;袁宏声;唐红;魏东明 | | | 目的:了解瓣膜置换术后对伴有持久性心房颤动(Af)的门诊患者进行药物复律的安全性及有效性。方法:瓣膜置换术后伴有持久性Af且无三尖瓣中度以上反流及明显肝肾功能异常的患者78例,治疗组38例,对照组40例。治疗组口服小剂量胺碘酮、卡托普利、维生素C、辛伐他汀联合复律治疗,每个月门诊随访1次。治疗6个月后进行心脏超声心动图及心电图检查,对照组患者根据情况采用地高辛或(和)美托洛尔控制心室率。结果:治疗组患者连续2~6(5.4±3.2)个月门诊药物复律治疗,14例恢复窦性心律,转复成功率36.84%(14/38)。对照组患者中无一例恢复窦性心律,2组差异有统计学意义(P<0.05)。治疗组患者中复律成功的患者与未成功的患者在年龄、术前Af持续时间、手术前后左房径改变(△LAD1)等方面的差异有统计学意义(P<0.05)。多元回归分析显示:瓣膜置换术后门诊患者持久性Af复律的有效性主要与患者年龄、Af持续时间、手术前后△LAD1有关。结论:瓣膜置换术后持久性Af患者的门诊药物复律是安全的,其有效性主要与患者年龄、Af持续时间、手术前后△LAD1有关。
【作者单位】：四川大学华西医院胸心外科;四川大学华西医院胸心外科;四川大学华西医院胸心外科;四川大学华西医院心内科;四川大学华西医院胸心外科 成都;610041;成都;610041;成都;610041;成都;610041
【关键词】：心脏瓣膜,人工;心房颤动;胺碘酮
【基金】：四川省科技厅攻关项目资助(No:05SG022-014-4)
【分类号】：R541.75;R654.2
【DOI】：CNKI:SUN:LCXB.0.2008-03-007
【正文快照】：
心房颤动(atrial fibrillation,Af)是临床上最常见的心律失常,在华西医院需施行心脏瓣膜置换术的患者中约64%伴有Af〔1〕。瓣膜置换术后尽管患者血流动力学得以改善,症状多明显缓解,但绝大多数患者的Af仍然持续存在。Af的持续存在对患者的康复及远期存活均有明显的不利影响。对 | | |
| | |  推荐 下载CAJ全文  下载PDF全文 | | | CAJViewer7.0阅读器支持所有CNKI文件格式，AdobeReader仅支持PDF格式 | | | | Pharmacological cardioversion of outpatients with atrial fibrillation after prosthetic valve replacement | | | QIAN Yongjun1 XIAO Xijun1 YUAN Hongsheng1 TANG Hong2 WEI Dongming1(1Department of Cardiothoracic Surgery;2Department of Cardiology;West China Hospital;Sichuan University;Chengdu;610041;China) | | | Objective:To explored the efficacy and safety of the pharmacological cardioversion of outpatients with persistent atrial fibrillation(Af) after prosthetic valve replacement.Method:We studied 78 outpatients who still had persistent atrial fibrillation after prosthetic valve replacement and these patients had no moderate to severe tricuspid regurgitation and abnormal liver and kidney function.The 78 outpatients were divided randomly into two groups: the treatment group(the group of 39 patients who received pharmacological cardioversion) and the control group(the group of the rest 40 patients).Echocardiography and electrocardiography examinations were performed before and six months after the study.Combination therapy with low-dose oral amiodarone,captopril,vitamin C,and simvastatin was administered to the outpatients in the treatment group with an once-a-month follow-up.Result:During 2-6 months(5.4±3.2) months of serial pharmacological cardioversion,of the 39 outpatients in the treatment group one quitted study,14 out of the rest 38 patients restored sinus rhythm,achieving a 36.84% success rate of cardioversion(14/38).No outpatient in the control group restored sinus rhythm with an obvious difference(P<0.05) between the treatment group and the control group.And also an obvious difference(P<0.05) in age,duration of preoperative Af,and △LAD1,existed between the patients with successful cardioversion and the patients with unsuccessful cardioversion.Multiple logistic regression analysis showed that the efficacy of cardioversion of permanent Af after prosthetic valve replacement is mainly related to the patients' age,duration of preoperative Af and △LAD1.Conclusion:The pharmacological cardioversion of outclinic patients with Af after prosthetic valve replacement is safe,its efficacy is mainly related to the patients' age,duration of preoperative Af and △LAD1.
【Keyword】：Heart valve prosthesis;Atrial fibrillation;Amiodarone |
| | | | | | 1 | 肖锡俊,袁宏声,唐红,黄云,邵换璋,钱永军; 二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗心房颤动 [J];中华心律失常学杂志; 2006年05期 | | 2 | 肖锡俊,袁宏声,唐红,黄云,崔永强,曹舸,田子朴,黄旭中; 术中盐水冲洗的射频改良迷宫手术治疗二尖瓣病变伴心房颤动 [J];中国胸心血管外科临床杂志; 2005年02期 |
|
| | | | | | 1 | Capucci A, Villani GQ, Piepoli ME, et al; The role of oral IC antiarrhythmic drugs in terminating atrial fibrillation [M];Current Opinion in Cardiology; 1999年 | | 2 | Yue L, Feng J, Gaspo R, et al; Ionic remodeling underlying action potential changes in a canine model of atrial fibrillation [M];Circ Res; 1997年 | | 3 | Wijffels MCEF, Kirchhof CJHJ, Dorland R, et al: Atrial fibrillation begets atrial fibrillation; A study in awake chronically instrumented goats [M];Circulation; 1995年 | | 4 | Cha TJ, Ehrlich JR, Zhang L , et al; Dissociation between ionic remodeling and ability to sustain atrial fibrillation during recovery from experimental congestive heart failure [M];Circulation; 2004年 | | 5 | Li D, Shinagawa K, Pang L, et al; Effects of angiotensin-converting enzyme inhibition on the development of the atrial fibrillation substrate in dogs with ventricular tachypacing-induced congestive heart failure [M];Circulation; 2001年 | | 6 | ATTUEL P,,CHILDERS R,CAUCHEMEZ B,etal; Failure in the rate adap tation of the atrial refrac-tory period:Its relationship to vulnerability[J]. [M];Int JCardiol; 1982年 | | 7 | LI D,PANG L,LEUNG T K,et al; Effects of an-giotensin converting enzyme inhibition on the develop-ment of the atrial fibrillation:substrate in dogs withventricular tachypacing induced congestive heart fail-ure[J]. [M];Circulation; 2001年 | | 8 | KOCHIADAKIS G E,IGOUMENIDIS N E,MAR-KETOU M E,et al; Low dose amiodarone and so-talol in the treat ment of recurrent,symptomatic atrialfibrillation:a comparative,placebo controlled study.[Miscellaneous Article][J]. [M];Heart; 2000年 | | 9 | ANNE W,WILLEMS R,VAN DER MERWE N,etal; Atrial fibrillation after radiofrequency ablation ofatrial flutter:preventive effect of angiotensin conver-ting enzyme inhibitors,angiotensin II receptor block-ers,and diuretics[J]. [M];Heart; 2004年 | | 10 | TIELEMAN R G,GOSSELINK A T,CRIJNS HJ,et al; Efficacy,safety,and determinants of conver-sion of atrial fibrillation and flutter with oral amioda-rone[J]. [M];AmJ Cardiol; 1997年 |
|
| | | | | | 1 | 钱永军,肖锡俊,罗通行,朱鹏,邵换璋; 二尖瓣置换手术患者外周血炎症标志物水平与心房颤动关系的研究 [J];华西医学; 2007年03期 | | 2 | 钱永军,肖锡俊,罗通行,朱鹏,邵换璋; 伴有心房颤动的二尖瓣置换术患者术前外周血ACE、CRP水平 [J];四川大学学报(医学版); 2008年01期 | | 3 | 张刚成,陶凉; 盐水冲洗的射频改良迷宫术治疗心房颤动的疗效分析 [J];中国胸心血管外科临床杂志; 2007年02期 | | 4 | 刘志勇,李旭东,王洪斌,李鸿雁,王玉华,何伟,周建明; 盐水冲洗射频改良迷宫Ⅲ手术治疗心房颤动的临床效果 [J];中国胸心血管外科临床杂志; 2006年06期 | | 5 | 武忠,陈保俊,曹彬,李庆国,王东进; 心内直视下射频消融改良迷宫术治疗心房颤动 [J];中国胸心血管外科临床杂志; 2007年04期 |
|
| | | | | | 1 | 萧锡俊!610041成都,田子朴!610041成都,唐红!610041成都,黄旭中!610041成都,石应康!610041成都,刘淑华!610041成都; 改良迷宫手术治疗二尖瓣病变伴慢性心房颤动的疗效 [J];中华胸心血管外科杂志; 2001年02期 |
|
| | | | | | 1 | Benussi S, Nascimbene S, Agricola E, et al; Surgical ablation of atrial fibrillation using the epicardial radiofrequency approach:mid-term results and risk analysis [M];Ann Thorac Surg; 2002年 | | 2 | Khargi K, Deneke T, Haardt H, et al; Saline-irrigated, cooledtip radiofrequency ablation is an effective technique to perform the maze procedure [M];Ann Thorac Surg; 2001年 | | 3 | Pasic M, Bergs P, Muller P, et al; Intraoperative radiofrequency maze ablation for atrial fibrillation: the Berlin modification [M];Ann Thorac Surg; 2001年 | | 4 | Williams MR, Stewart JR, Bolling SF, et al; Surgical treatment of atrial fibrillation using radiofrequency energy [M];Ann Thorac Surg; 2001年 | | 5 | Gillinov AM, Blackstone EH, McCarthy PM; Atrial fibrillation: current surgical options and their assessment [M];Ann Thorac Surg; 2002年 | | 6 | Sie HT, Beukema WP, Misier AR, et al; Radiofrequency modified maze in patients with atrial fibrillation undergoing concomitant cardiac surgery [M];J Thorac Cardiovasc Surg; 2001年 | | 7 | Sie HT, Beukema WP, Elvan A, et al; New strategies in the surgical treatment of atrial fibrillation [M];Cardiovasc Res; 2003年 | | 8 | Sueda T, Nagata H, Orihashi K, et al; Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations [M];Ann Thorac Surg; 1997年 | | 9 | Guden M, Akpinar B, Sanisoglu I , et al; Intraoperative salineirrigated radiofrequency modified Maze procedure for atrial fibrillation [M];Ann Thorac Surg; 2002年 | | 10 | Wijffels MC, Kirchhof CJ, Dorland R, et al; Atrial fibrillation begets atrial fibrillation.A study in awake chronically instrumented goats [M];Circulation; 1995年 |
|
| | | | | | 1 | 吴宁; 心房颤动处理 [A];第六次全国中西医结合心血管会学术会议论文汇编 [C]; 2002年 | | 2 | 孙艺红,胡大一; 非瓣膜病心房颤动转复窦性心律远期复发的影响因素 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 3 | 刘岩,王珂; 组织及血流多普勒联合心尖搏动图评价心房颤动复律后心房顿抑和心房功能的临床研究 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 4 | 田莉莉,黄从新,杨波; 心房颤动患者KV1.5mRNA表达的研究 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 5 | 金龙英; 心房颤动易颤期时限的探讨 [A];2005年浙江省心电生理与起搏学术年会论文汇编 [C]; 2005年 | | 6 | 金贤,倪幼方,方唯一; 非瓣膜病心房颤动华法林抗凝简易给药和监测方案的临床研究 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 7 | 梁延春,韩雅玲,王祖禄,徐凯,张荣庆,贾国良; 人心房肌细胞内钙离子浓度与心房颤动的关系 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 8 | 张小云,植爱容; 老年人阵发性心房颤动的动态心电图分析 [A];第七届全国老年医学学术会议暨海内外华人老年医学学术会议论文汇编 [C]; 2004年 | | 9 | 程中伟,朱文玲,刘博江,张军,方全; 心房颤动的综合治疗:一项单中心210例心房颤动研究结果 [A];中华医学会心血管病学分会第八次全国心血管病学术会议汇编 [C]; 2006年 | | 10 | 孙勇,蒋晨阳,傅国胜,何红,赵林水,刘少稳,董建增; Carto指导下环肺静脉口线性消融治疗心房颤动的体会 [A];2006年浙江省心电生理与起搏学术年会论文汇编 [C]; 2006年 |
|
|
|