Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery
Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery
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DOI：
10.1056/nejm199712183372501
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发表时间：
1997-12-18
影响因子：
158.5
通讯作者：
Morady, F
中科院分区：
文献类型：
--
作者：
Daoud, EG;Strickberger, SA;Morady, F
心房颤动常发生在心脏直视手术后，并可能延迟出院。本研究的目的是评估使用术前胺碘酮预防心脏手术后房颤。方法124例心脏手术患者随机分为两组，每组64例，口服胺碘酮或安慰剂7天。治疗包括每天600 mg胺碘酮，持续7天，然后每天200 mg，直至出院。在13+/-7天内，胺碘酮的平均（+/-SD）术前总剂量为4.8+/-0.96 g。结果胺碘酮组64例患者中有16例（25%）发生术后房颤，安慰剂组60例患者中有32例（53%）发生术后房颤（P=0.003）。胺碘酮组患者住院天数显著少于安慰剂组患者（6.5+/-2.6 vs. 7.9+/-4.3天，P=0.04）。胺碘酮治疗组8例（12%）和安慰剂组6例（10%，P=0.78）发生非致命性术后并发症。胺碘酮组3例（5%）和安慰剂组2例（3%，P=1.00）发生致命性术后并发症。胺碘酮组的总住院费用明显低于安慰剂组（18，375美元+/-13，863美元vs 26，491美元+/-23，837美元，P=0.03）。结论复杂心脏手术患者术前口服胺碘酮耐受性良好，可显著降低术后房颤的发生率，缩短住院时间，降低住院费用。(C)1997年，马萨诸塞州医学会。
Background Atrial fibrillation occurs commonly after open-heart surgery and may delay hospital discharge. The purpose of this study was to assess the use of preoperative amiodarone as prophylaxis against atrial fibrillation after cardiac surgery. Methods In this double-blind, randomized study, 124 patients were given either oral amiodarone (64 patients) or placebo (60 patients) for a minimum of seven days before elective cardiac surgery. Therapy consisted of 600 mg of amiodarone per day for seven days, then 200 mg per day until the day of discharge from the hospital. The mean (+/-SD) preoperative total dose of amiodarone was 4.8+/-0.96 g over a period of 13+/-7 days. Results Postoperative atrial fibrillation occurred in 16 of the 64 patients in the amiodarone group (25 percent) and 32 of the 60 patients in the placebo group (53 percent) (P=0.003). Patients in the amiodarone group were hospitalized for significantly fewer days than were patients in the placebo group (6.5+/-2.6 vs. 7.9+/-4.3 days, P=0.04). Nonfatal postoperative complications occurred in eight amiodarone-treated patients (12 percent) and in six patients receiving placebo (10 percent, P=0.78). Fatal postoperative complications occurred in three patients who received amiodarone (5 percent) and in two who received placebo (3 percent, P=1.00). Total hospitalization costs were significantly less for the amiodarone group than for the placebo group ($18,375+/-$13,863 vs. $26,491+/-$23,837, P=0.03). Conclusions Preoperative oral amiodarone in patients undergoing complex cardiac surgery is well tolerated and significantly reduces the incidence of postoperative atrial fibrillation and the duration and cost of hospitalization. (C) 1997, Massachusetts Medical Society.