围术期应用胺碘酮预防肺切除术后房颤的临床研究(1)
[摘要]目的 评价胺碘酮预防肺切除术后心房颤动的有效性和安全性。方法 选取2014年4月～2015年6月本院130例接受肺叶或全肺切除术后患者为研究对象，按照随机原则分为胺碘酮组(接受预防性使用胺碘酮，n=65)和对照组(n=65)，比较两组患者在住院期间需要治疗的房颤及房颤持续>30 s的发病率、住重症监护室时间和总住院时间。结果 胺碘酮组房颤发病率为13.8%，明显低于对照组的32.3%，差异有统计学意义(P<0.05)，胺碘酮组术后持续>30 s的房颤发病率为13.8%，低于对照组的33.8%，差异有统计学意义(P<0.01)；胺碘酮组总住院时间和ICU停留时间明显短于对照组(P<0.05)；两组术后不良事件发生率比较，差异无统计学意义(P>0.05)。结论 预防性使用胺碘酮可明显降低肺切除术后房颤的发病率，并且显著减少重症监护室停留时间。
[关键词]胺碘酮；预防；肺切除术术后；房颤
[中图分类号] R655.3 [文献标识码] A [文章编号] 1674-4721(2016)10(a)-0038-03
[Abstract]Objective To evaluate efficacy and safety of Amiodarone for preventing atrial fibrillation after pulmonary resection.Methods 130 cases of accepting lobectomy or pneumonectomy in the hospital from April 2014 to June 2015 were randomly divided into Amiodarone group (prophylactic use of Amiodarone，n=65) and control group (n=65)，incidence of atrial fibrillation during hospitalization in need of treatment and atrial fibrillation more than 30 s，stay in intensive care unit and total length of hospital stay between two groups were compared.Results The incidence of atrial fibrillation in the Amiodarone group was 13.8%，significantly lower than 32.3% in the control group (P<0.05)，incidence of atrial fibrillation more than 30 s in the Amiodarone group was 13.8%，lower than 33.8% in the control group (P<0.01)；in the Amiodarone group，stay in intensive care unit and the total length of hospital stay was significantly shorter than that in the control group respectively，the difference was statistically significant (P<0.05)；incidence of postoperative adverse events was not statistically significant (P>0.05).Conclusion Prophylactic use of Amiodarone can significantly reduce incidence of atrial fibrillation after pulmonary resectio，and significantly reduce residence time in intensive care unit.
[Key words]Amiodarone；Prevention；After pulmonary resectio；Atrial fibrillation
心房颤动(房颤)是肺切除术后一种常见的并发症，发病率在全肺切除术中为24%～67%，而在肺叶切除术后为12%～30%[1]。肺切除术后房颤可导致患者出现血液动力学不稳定、中风等并发症，从而延长总住院时间和增加住院费用[2]。大量的前瞻性试验已证明胺碘酮是一种治疗术后房颤的有效药物[3]，尤其对于预防心脏外科手术后房颤有良好的效果[4]。美国心脏协会、美国心脏病学院、欧洲心脏病学会和美国大学胸科医师学会推荐将胺碘酮作为预防冠状动脉搭桥术后房颤的药物[5]。但目前尚未报道针对预防肺切除术后房颤的前瞻性随机对照研究，本研究旨在评价胺碘酮用于预防肺切除后房颤的有效性和安全性，现报道如下。
1资料与方法
1.1一般资料
选取2014年4月～2015年6月江西中医学院附属医院胸外科住院接受肺叶切除术或全肺切除术的130例患者，按照随机原则分为胺碘酮组(接受预防性使用胺碘酮，n=65)和对照组(n=65)。排除标准：既往有房颤或心房扑动病史，发生在外科手术期间需要治疗的心房颤动或心房扑动，对胺碘酮有严重不良反应或禁忌证(即肺纤维化、甲状腺功能障碍、肝毒性等)者，肝功能异常者；对入选患者的术前资料进行详细采集，内容主要包括年龄、性别、既往病史(糖尿病、高血压、高血脂等)及手术方式，两组患者术前在年龄、性别、既往病史及手术方式比较，差异无统计学意义(P>0.05)(表1)。 (刘小雄 熊汉鹏 李卉)
[关键词]胺碘酮；预防；肺切除术术后；房颤
[中图分类号] R655.3 [文献标识码] A [文章编号] 1674-4721(2016)10(a)-0038-03
[Abstract]Objective To evaluate efficacy and safety of Amiodarone for preventing atrial fibrillation after pulmonary resection.Methods 130 cases of accepting lobectomy or pneumonectomy in the hospital from April 2014 to June 2015 were randomly divided into Amiodarone group (prophylactic use of Amiodarone，n=65) and control group (n=65)，incidence of atrial fibrillation during hospitalization in need of treatment and atrial fibrillation more than 30 s，stay in intensive care unit and total length of hospital stay between two groups were compared.Results The incidence of atrial fibrillation in the Amiodarone group was 13.8%，significantly lower than 32.3% in the control group (P<0.05)，incidence of atrial fibrillation more than 30 s in the Amiodarone group was 13.8%，lower than 33.8% in the control group (P<0.01)；in the Amiodarone group，stay in intensive care unit and the total length of hospital stay was significantly shorter than that in the control group respectively，the difference was statistically significant (P<0.05)；incidence of postoperative adverse events was not statistically significant (P>0.05).Conclusion Prophylactic use of Amiodarone can significantly reduce incidence of atrial fibrillation after pulmonary resectio，and significantly reduce residence time in intensive care unit.
[Key words]Amiodarone；Prevention；After pulmonary resectio；Atrial fibrillation
心房颤动(房颤)是肺切除术后一种常见的并发症，发病率在全肺切除术中为24%～67%，而在肺叶切除术后为12%～30%[1]。肺切除术后房颤可导致患者出现血液动力学不稳定、中风等并发症，从而延长总住院时间和增加住院费用[2]。大量的前瞻性试验已证明胺碘酮是一种治疗术后房颤的有效药物[3]，尤其对于预防心脏外科手术后房颤有良好的效果[4]。美国心脏协会、美国心脏病学院、欧洲心脏病学会和美国大学胸科医师学会推荐将胺碘酮作为预防冠状动脉搭桥术后房颤的药物[5]。但目前尚未报道针对预防肺切除术后房颤的前瞻性随机对照研究，本研究旨在评价胺碘酮用于预防肺切除后房颤的有效性和安全性，现报道如下。
1资料与方法
1.1一般资料
选取2014年4月～2015年6月江西中医学院附属医院胸外科住院接受肺叶切除术或全肺切除术的130例患者，按照随机原则分为胺碘酮组(接受预防性使用胺碘酮，n=65)和对照组(n=65)。排除标准：既往有房颤或心房扑动病史，发生在外科手术期间需要治疗的心房颤动或心房扑动，对胺碘酮有严重不良反应或禁忌证(即肺纤维化、甲状腺功能障碍、肝毒性等)者，肝功能异常者；对入选患者的术前资料进行详细采集，内容主要包括年龄、性别、既往病史(糖尿病、高血压、高血脂等)及手术方式，两组患者术前在年龄、性别、既往病史及手术方式比较，差异无统计学意义(P>0.05)(表1)。 (刘小雄 熊汉鹏 李卉)