全球精选文摘 - 早期及标准的胺碘酮治疗对术后出现心动过速患儿的疗效

Impact of early and standardized treatment with amiodarone on therapeutic success and outcome in pediatric patients with postoperative tachyarrhythmia

Haas NA, Camphausen CK 2009/5/27 10:48:50

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J Thorac Cardiovasc Surg, 2008,

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Abstract
Objective:
Effects of timing of inception of amiodarone antiarrhythmic treatment after corrective surgery for congenital heart defects are not yet well defined.

Methods:
In a 10-year prospective observational study, 71 of 2651 patients (2885 procedures, 2106 bypass procedures) received amiodarone for newly detected postoperative atrial (n=70) or ventricular (n=7) tachyarrhythmia: early treatment (initiation within 60 minutes of arrhythmia detection) and late treatment (after that). From an interim analysis, a treatment protocol was established (32 patients). Inotropic requirements were monitored, as were heart rate, blood pressure, central venous pressure, and sedation requirements.

Results:
With early treatment (n=29), delay before start of amiodarone was 40.7±21.9 minutes, versus 227.7±228.1 minutes (P<.001) with late treatment (n=42). There were significant benefits of early treatment for times to rate (155.9±299.8 vs 407.6±376.9 minutes, (P<.001) and rhythm control (400.4±845 vs 1038.5±1158.4 minutes, P<.001), reduction in dose needed for rate control (28.2±45.2 vs 66.5±137.5mg, P<.025), and significant reduction in pediatric cardiac intensive care unit stay (3.32±1.9 vs 5.26±4.27 days, P<.01). There were continuous improvements in heart rate, blood pressure, and filling pressures without additional inotropic requirements or side effects.

Conclusion:
Early treatment of postoperative tachyarrhythmia with amiodarone according to a standardized treatment protocol is safe and has beneficial effects on arrhythmia control and pediatric cardiac intensive care unit stay.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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