Crit Care:胺碘酮可有效预防重症患者房颤的复发

2017-06-23 MedSci MedSci原创

心房颤动是重症监护室一种常见的心律失常,胺碘酮是ICU一种常用的抗心律失常药物,但一直缺乏证据指导胺碘酮的临床用药。本研究是一项回顾性研究,研究纳入三级医院外科重症监护室177名有新发房颤的重症患者。胺碘酮的用药(包括剂量和给药时间)以在监护室治疗期间房颤再发次数评估。已知的诱导房颤再发的因素,例如强心药物的应用、本身患有心脏疾病、查而森合并症指数、血清镁离子浓度、液体平衡、血清钾离子浓度等应纳入

房颤动是重症监护室一种常见的心律失常,胺碘酮是ICU一种常用的抗心律失常药物,但一直缺乏证据指导胺碘酮的临床用药。

本研究是一项回顾性研究,研究纳入三级医院外科重症监护室177名有新发房颤的重症患者。胺碘酮的用药(包括剂量和给药时间)以在监护室治疗期间房颤再发次数评估。已知的诱导房颤再发的因素,例如强心药物的应用、本身患有心脏疾病、查而森合并症指数、血清镁离子浓度、液体平衡、血清钾离子浓度等应纳入分析,使用逐步逻辑回归对数据记性分析。

受试者平均年龄69岁(60-75),APACHE Ⅱ评分平均得分22(17-28),查而森合并症指数2(1-4)。静脉给予负荷剂量胺碘酮(p=0.02),继而给予胺碘酮持续静脉泵入直至转出ICU(p=0.01),结果证明可以减少心律失常的复发。在使用静脉强心药物时,如终止胺碘酮泵入可导致房颤再发(p<0.001),尤其是在已诊断为充血性心力衰竭(p=0.04)及全身性炎症反应综合征(p=0.02)的患者更易发生。

由此我们可以得出:ICU发现房颤后应立即使用负荷量胺碘酮,并持续静脉泵入维持量。在使用强心药物时应静脉使用胺碘酮,直到强心药物停药。

原始出处:

Mitri? G1, Udy A2,3, Bandeshe H4, et al. Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill. Crit Care. 2016 Apr 2;20:90. doi: 10.1186/s13054-016-1252-2.

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    2017-07-08 虈亣靌

    不错的文章值得学习

    0

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    2017-07-04 虈亣靌

    不错的,学习了,谢谢分享!

    0

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    2017-06-24 虈亣靌

    不错的,学习了,谢谢分享!

    0

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房颤射频消融术后使用抗心律失常药物目前已经成为习惯用药,但是术后是否用药仍然存在争议。本研究为前瞻性随机对照研究,旨在研究房颤射频消融术后前3个月内使用胺碘酮究竟是否会降低房颤再发率。

EUR HEART J:房颤会导致认知能力下降和痴呆吗?如何治疗?

房颤(AF)和老年痴呆都是老年人的疾病。随着年龄的增长,房颤和认知能力下降的发生率也会增加。这两种常见情况的巧合可能简单地解释为一个共同的因素,即年龄的增加。然而,最近的研究提供了证据,证明血管危险因素和血管疾病不仅对血管性痴呆有影响,而且对退化性痴呆,如阿尔茨海默氏病也有影响。心房颤动增加了中风的风险,而中风是一种重要的危险因素,并预示着认知能力下降和痴呆。许多研究表明,即使在没有中风的病人中,