伊布利特转复房颤对跨壁复极异质性及室性心律失常的影响分析

伊布利特转复房颤对跨壁复极异质性及室性心律失常的影响分析

摘要目的分析伊布利特轉復心房颤动（房颤）对跨壁复极异质性及室性心律失常的影响。方法68例房颤患者依据治疗方法不同分为胺碘酮组与伊布利特组，每组34例。胺碘酮组患者实施胺碘酮治疗，伊布利特组患者实施伊布利特治疗。对比分析两组患者的房颤转复成功率，并统计分析两组患者用药之前、用药后4 h内的QT间期和Tpeak-end/QT间期比值变化。结果34例伊布利特组患者中有21例患者转复成功，成功率为61.8%，34例胺碘酮组患者中有12例患者转复成功，成功率为35.3%，两组成功率比较，差异具有统计学意义（P＜0.05）。伊布利特组患者用药后2 h内QT间期与用药前比较显著延长，差异具有统计学意义（P＜0.05），伊布利特组患者用药后30 min内Tpeak-end/QT 间期比值与用药前比较明显升高，差异具有统计学意义（P＜0.05）；胺碘酮组患者用药后的QT间期与用药前比较显著延长，差异具有统计学意义（P＜0.05），胺碘酮组患者用药后的Tpeak-end/QT间期比值与用药前比较差异无统计学意义（P>0.05）。结论在房颤患者临床治疗中，伊布利特治疗转复成功率显著高于胺碘酮，并能够对患者QT间期、Tpeak-end/QT间期比值显著改善，值得推广。

关键词伊布利特；心房颤动；跨壁复极异质性；室性心律失常

【Abstract】Objective To analyze influence by ibutilide for atrial fibrillation cardioversion on transmural repolarization heterogeneity and ventricular arrhythmias. Methods A total of 68 patients with atrial fibrillation were divided by different treatment measures into amiodarone group and ibutilide group，with 34 cases in each group. The amiodarone group received amiodarone for treatment，and the ibutilide group received ibutilide for treatment. Comparative analysis was made on successful cardioversion rate between the two groups，along with statistical analysis of changes in QT interval and Tpeak-end/QT interval ratio before and in 4 h after medicine administration. Results Among 34 patients in the ibutilide group，there were 21 cases with successful cardioversion，and their success rate was 61.8%. Among 34 patients in the amiodarone group，there were 12 cases with successful cardioversion，and their success rate was 35.3%. The difference of success rate had statistical significance between the two groups （P＜0.05）. The ibutilide group had obviously longer QT interval in 2 h after medicine administration than that before medicine administration，and the difference had statistical significance （P＜0.05）. The ibutilide group had obviously higher Tpeak-end/QT interval ratio in 30 min after medicine administration than that before medicine administration，and the difference had statistical significance （P＜0.05）. The amiodarone group had much longer QT interval after medicine administration than that before medicine administration，and the difference had statistical significance （P＜0.05）. There was no statistically significant difference of Tpeak-end/QT interval ratio before and after medicine administration in the amiodarone group （P>0.05）. Conclusion In clinical treatment of atrial fibrillation patients，ibutilide shows remarkably higher success rate in cardioversion than amiodarone. Ibutilide can also excellently improve QT interval and

Tpeak-end/QT interval ratio during treatment，and it is worth promoting.【Key words】Ibutilide；Atrial fibrillation；Transmural repolarization heterogeneity；Ventricular arrhythmias

在我国，患有房颤的患者大多为30岁以上的人群，该疾病是最为常见的心律失常，房颤所致的脑卒中具有较高的致残率与致死率，给患者及家庭甚至社会带来了非常沉重的负担[1-4]。伊布利特属于一种注射剂，适用于房颤或者心房扑动（房扑）逆转成窦性心律，作为新型Ⅲ类抗心律失常的一种药物，伊布利特具有较强的安全性以及转复效果，能够有效的治疗房颤[5-7]。本次研究选取68例本院收治的房颤患者，深入的探讨伊布利特在不同时间段对患者QT 间期与Tpeak-end/QT间期比值的影响。

1 资料与方法

1. 1 一般资料选取2013年10月～2016年10月本院收治的68例房颤患者，所有患者均符合房颤相关诊断标准，患者的发病时间均为48 h～7 d，不能自行转复。将68例房颤患者依据治疗方法不同分为胺碘酮组与伊布利特组，每组34例。

胺碘酮组男19例，女15例，平均年龄（55.7±18.2）岁，平均体重（67.5±10.2）kg，平均收缩压（125.8±18.5）mm Hg （1 mm Hg=

0.133 kPa），平均舒张压（72.3±14.8）mm Hg；伊布利特组男20例，

女14例，平均年龄（57.4±15.2）岁，平均体重（68.5±11.4）kg，平均收缩压（126.9±19.2）mm Hg，平均舒张压（72.1±13.8）mm Hg。

两组患者性别、年龄、体重、血压等一般资料比较，差异无统计学意义（P>0.05），具有可比性。

1. 2 给药方法伊布利特组的所有患者中体重>60 kg者首次10 min内静脉注射伊布利特1 mg，若患者在注射完后未能转复窦性心律者，再次静脉注射1 mg 伊布利特，直至转复窦性心律。针对体重0.05）。

3 讨论

伊布利特对房颤以及房扑转复具有显著性的效果，是新型Ⅲ類抗心律失常的一种药物。跨室壁复极离散度（TDR）的增加可以作为预测室性心律失常发生的有效指标，其能够伴随著心律失常的发生率而明显的增高[10-12]。但近些年来，Tpeak-end/QT间期的比值已经成为了预测室性心律失常的最新指标，与TDR相比而言，更具准确性与稳定性[13，14]。伊布利特与胺碘酮都是作为Ⅲ类抗心律失常的药物，但伊布利特抑制IK电流的快成分IKr，而胺碘酮抑制该电流的慢成分IKs，胺碘酮阻滞IKs之后，IKs/IKr值减小，跨壁复极异质性反而降低，不会增加患者诱发恶性室性心律失常的风险[15]。伊布利特抑制