摘要:目的:探討胺碘酮治療充血性心力衰竭(CHF)心房顫動(dòng)伴快速心室率的臨床療效。方法: 將106例各種原因所致的房顫伴快速心室率的CHF患者按入院順序隨機(jī)分為治療組及對(duì)照組。兩組抗CHF基礎(chǔ)治療相同,治療組加用靜脈負(fù)荷量胺碘酮150 mg后,再以1 000μg/min靜脈點(diǎn)滴維持6小時(shí),500 μg/min靜滴18小時(shí)。同時(shí)口服胺碘酮0.2,3次/d,1周;再0.2,2次/d,1周以后以0.2,1次/d 至觀察終點(diǎn),隨診為12個(gè)月。 結(jié)果: 治療組53例使用胺碘酮治療可顯著增加抗心律失常有效性,改善左室射血分?jǐn)?shù),減少心力衰竭再住院率,42例患者轉(zhuǎn)復(fù)為室性心律。 結(jié)論: 靜脈及口服胺碘酮同時(shí)應(yīng)用治療充血性心力衰竭房顫是有效和安全的。Abstract: Objective: To explore the effect and safety of amiodarone in the treatment of atrial fibrillation with congestive heart failure. Methods:One hundred and six patients of AF with CHF caused by a variety of reasons were randomly divided into treatment group and control group according to hospitalized order.The two groups were treated with the same antiCHF therapy,the treatment group was treated with loaded intravenous amiodarone 150 mg;and then dripped to 1 000 μg/min for 6 hours, dripped to 500 μg/min for 18 hours. United with oral amiodarone by amiodarone tablets with 0.2 g,3 time/day a week,further 0.2 g,2 times/day a week,later 0.2 g,1 times/day to the end.The end of followup time was 12 months. Results:In treatment group,53 cases with amiodarone therapy can significantly increase the effectives of antiarrhythmic, improve the rate and heart failure rehospitalization.42/53 patients reversed to sinus rhythm. Conclusion:The results showed it is effective and safe united with intravenous amiodarone and oral amiodarone in treatment of atrial fibrillation with organic heart disease.
表征極短時(shí)（＜1 min）心率變異性（HRV）的分析參數(shù)通常隨時(shí)間呈現(xiàn)出復(fù)雜的變化模式，這種隨時(shí)間變化的波動(dòng)很容易干擾對(duì)心血管狀態(tài)的正確判斷。本文將年齡匹配的41例健康人（對(duì)照組）和25例充血性心力衰竭（CHF）患者（實(shí)驗(yàn)組）的長時(shí)HRV序列劃分成多段極短時(shí)序列，計(jì)算同一HRV參數(shù)在多段極短時(shí)序列中的變異系數(shù)以及多次組間t檢驗(yàn)中差異有統(tǒng)計(jì)學(xué)意義的檢驗(yàn)比例，以此探討部分極短時(shí)HRV分析參數(shù)在揭示不同狀態(tài)下心血管系統(tǒng)功能差異時(shí)的穩(wěn)定性；此外，通過對(duì)受試者工作特征（ROC）曲線的分析以及人工神經(jīng)網(wǎng)絡(luò)的建模，評(píng)估了這些參數(shù)對(duì)對(duì)照組和實(shí)驗(yàn)組進(jìn)行分類的效果。本文結(jié)果表明：① 基于復(fù)雜網(wǎng)絡(luò)分析的度分布熵指標(biāo)有著最小的變異系數(shù)且對(duì)病理狀態(tài)敏感（79.75%情況下對(duì)照組和實(shí)驗(yàn)組的差異有統(tǒng)計(jì)學(xué)意義），可為臨床醫(yī)生提供一個(gè)診斷CHF患者的輔助指標(biāo)；② 將龐加萊散點(diǎn)圖進(jìn)行橢圓擬合后，對(duì)照組和實(shí)驗(yàn)組的橢圓短長軸之比（SDratio）在98.5%的情況下差異有統(tǒng)計(jì)學(xué)意義；在人工神經(jīng)網(wǎng)絡(luò)建模時(shí)，僅使用SDratio對(duì)對(duì)照組和實(shí)驗(yàn)組進(jìn)行分類的正確率為71.87%，表明SDratio或可作為CHF患者的智能診斷指標(biāo)；③ 仍需尋找可用于極短時(shí)HRV分析研究且對(duì)CHF患者更加敏感特異的穩(wěn)定指標(biāo)。