低分子肝素联合华法林对心房颤动早期复律的影响

摘要

OBJECTIVE:To observe the effect of low molecular weight heparin combined with warfarin on early cardioversion of atrial fibrillation. METHODS:Totally 58 patients with atrial fibrillation were randomly divided into observation group (32 cas-es)and control group(26 cases). All patients were given conventional treatment;meanwhile,control group was orally treated with warfarin with initial dose of 2.5 mg,once a day,and when international normalized ratio (INR) was maintained at 2.5-3 weeks, amiodarone was orally given for cardioversion;observation group was subcutaneously injected warfarin (the same dose as control group)+ Low molecular weight heparin for injection 5 000 U for continuous 3-5 d,q12 h,it was stopped when INR was 2.5 and cardioversion was started at the same time. If the heart rate was fast,a loading dose of 150 mg amiodarone was given to maintain 6 h with rate of 1 mg/min and more than 24 h with rate of 0.5 mg/min. If hemodynamics is stable,amiodarone was orally given for cardioversion,it was not achieved after 4 weeks of amiodarone or QTc>0.50,it was replaced by controlling heart rate and warfa-rin. All patients were continuously given warfarin for 4 weeks after cardioversion to maintain INR in about 2.5. After one month of using amiodarone,the cardioversion rate,recurrence rate,cardioversion time,total amount of amiodarone and incidence of ad-verse reactions were evaluated. RESULTS:The cardioversion rate,recurrence rate,cardioversion time and total amount of amioda-rone in observation group were significantly better than control group,the differences were statistically significant(P<0.05). There was no significant difference in the incidence of adverse reactions between 2 groups (P>0.05). CONCLUSIONS:Low molecular weight heparin combined with warfarin can improve the success rate of early cardioversion of atrial fibrillation,without bleeding and embolic complications and with good safety.%目的：观察低分子肝素联合华法林对心房颤动（简称房颤）早期复律的影响。方法：58例特发性房颤患者随机分为观察组（32例）和对照组（26例）。两组患者均给予常规治疗。与此同时，对照组患者给予华法林钠片初始剂量2.5 mg，口服，每日1次，待患者国际标准化比值（INR）维持在2.5左右3周后口服胺碘酮转复心律。观察组患者给予华法林（用法同对照组）+注射用低分子量肝素钠5000 U，皮下注射，q12 h，连用3～5 d，在INR 2.5左右时停用，3周后开始转复心律，如患者心率较快，给予胺碘酮负荷剂量150 mg，以1 mg/min维持6 h，以0.5 mg/min维持24 h以上；如患者血流动力学稳定，则口服胺碘酮转复心律，胺碘酮应用4周未能复律或QTc＞0.50 ms者，停服胺碘酮，改用控制心率药物加华法林治疗。两组患者心律转复后均继续服用华法林4周，维持INR在2.5左右。应用胺碘酮1个月后评价两组患者转复率、复发率、转复时间、胺碘酮总量及不良反应发生情况。结果：观察组患者转复率、复发率、转复时间、胺碘酮总量均显著优于对照组，差异均有统计学意义（P＜0.05）。两组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：低分子肝素联合华法林可提高房颤早期复律成功率，不增加出血及栓塞并发症，安全性较好。