利多卡因联合瑞舒伐他汀治疗不耐受胺碘酮的急性冠状动脉综合征伴急性心律失常的临床疗效

doi:10.3969/j.issn.1004-583X.2021.04.003

摘要/Abstract

摘要：

目的探讨不耐受胺碘酮的急性冠状动脉综合征(ACS)伴急性心律失常采用利多卡因联合瑞舒伐他汀治疗的效果。方法选取我院收治的不耐受胺碘酮的ACS患者110例,按治疗方法分成两组, 对照组55例,给予利多卡因;观察组55例,给予利多卡因联合瑞舒伐他汀。两组均行溶栓、低分子肝素治疗,对比两组临床治疗效果、心脏功能、炎性因子和氧化应激指标变化情况。结果观察组总有效率高于对照组(96.36% vs 85.45%,P<0.05)。治疗后,观察组心率变异性各指标高于对照组(P<0.05);治疗后,观察组血清肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、丙二醛(MDA)低于对照组,超氧化物歧化酶(SOD)高于对照组(P<0.05)。结论不耐受胺碘酮的ACS伴急性心律失常采用利多卡因联合瑞舒伐他汀治疗可降低其炎症反应与氧化应激,调节心率变异性,从而提高抗心律失常疗效。

关键词: 急性冠状动脉综合征, 胺碘酮, 心律失常, 心性, 瑞舒伐他汀, 利多卡因

Abstract:

Objective To investigate the effects of lidocaine combined with rosuvastatin in treating acute coronary syndrome(ACS) concurrent with acute arrhythmia among patients intolerant of amiodarone. Methods A total of 110 patients with ACS who were intolerant of amiodarone were recruited from our hospital, and they were divided into two groups, the control group (n=55) were given thrombolytic therapy, the observation group (n=55) were given idocaine combined with rosuvastatin. The both groups were treated with thrombolysis and low molecular weight heparin, and the changes in clinical efficacy, cardiac function, inflammatory factors and oxidative stress indicators were compared between two groups. Results The total response rate in the observation group was significantly higher than that in the control group (96.36% vs 85.45%,P<0.05). After treatment, the indexes of heart rate variability (HRV) in the observation group were higher than those in control group (P<0.05); HRV indexes in the observation group were higher than those in the control group (P<0.05); the serum tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein(hs-CRP) and malondialdehyde(MDA) in the observation group were lower than those in the control group, and superoxide dismutase (SOD) in the observation group was higher than that in the control group (P<0.05). Conclusion Lidocaine combined with rosuvastatin in treating ACS concurrent with acute arrhythmia among patients intolerant of amiodarone can reduce inflammatory response and oxidative stress, regulate HRV, and further improve the efficacy of antiarrhythmias.

Key words: acute coronary syndrome, amiodarone, arrhythmias, cardiac, rosuvastatin, lidocaine

中图分类号:

R542.2

崔国艳, 郑雯, 张丽伟. 利多卡因联合瑞舒伐他汀治疗不耐受胺碘酮的急性冠状动脉综合征伴急性心律失常的临床疗效[J]. 临床荟萃, 2021, 36(4): 311-314.

Cui Guoyan, Zheng Wen, Zhang Liwei. Clinical efficacy of lidocaine combined with rosuvastatin in treating acute coronary syndrome concurrent with acute arrhythmia among patients intolerant of amiodarone[J]. Clinical Focus, 2021, 36(4): 311-314.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.04.003

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I4/311

图/表 4

参考文献 23

[1]	宋琴, 王聪霞, 张勇. ACS继发心律失常与炎性因子相关性研究[J]. 西南国防医药, 2016,26(11):1312-1313.
[2]	傅国栋, 金东明. 瑞舒伐他汀联用美托洛尔治疗胺碘酮禁忌的持续性心房颤动患者的疗效分析[J]. 中国临床保健杂志, 2011,14(5):531-532.
[3]	刘娜, 张抗怀, 李刚. 常规剂量胺碘酮导致长QT间期综合征一例[J]. 药学服务与研究, 2016,16(2):97-97.
[4]	张帆, 洪丽荣. 胺碘酮相关甲状腺功能障碍的诊治[J]. 中国实用内科杂志, 2019, 39(04):32-37+42.
[5]	心律失常紧急处理专家共识[J]. 中华心血管病杂志, 2013,41(5):363-376.
[6]	兰振和, 马婧, 赵金霞, 等. 瑞舒伐他汀治疗急性冠状动脉综合征合并心律失常的疗效及其对血清炎性因子的影响[J]. 实用临床医药杂志, 2018,22(3):41-43, 47.
[7]	梁峰, 沈珠军, 方全, 等. 2014年美国心脏协会/美国心脏病学院关于非ST抬高急性冠状动脉综合征患者治疗指南(二)[J]. 中国心血管病研究, 2015,13(8):689-692.
[8]	赵媛媛, 章袁. 胺碘酮致不良反应173例文献分析[J]. 实用医药杂志, 2015,32(4):353-355.
[9]	Mohammadzadeh A, Towfighi F, Jafari N. Effect of magnesium on arrhythmia incidence in patients undergoing coronary artery bypass grafting[J]. ANZ J Surg, 2018,88(6):612-615. doi: 10.1111/ans.14056 pmid: 28544600
[10]	张瑾, 陈垚, 卢洋, 等. 稳心颗粒联合胺碘酮治疗冠心病心律失常的Meta分析[J]. 中药新药与临床药理, 2017,28(2):105-109.
[11]	Shojaee M, Feizi B, Miri R, et al. Intravenous amiodarone versus digoxin in atrial fibrillation rate control: A clinical trial[J]. Emerg (Tehran), 2017,5(1):e29.
[12]	张栩. 胺碘酮与利多卡因对急性冠状动脉综合征并室性心律失常患者疗效及不良反应的影响[J]. 中国药物与临床, 2018,18(1):96-98.
[13]	崔吉宏, 张金蓉. 心率变异性与老年冠心病者严重心律失常的相关性[J]. 海南医学, 2016,27(13):2187-2189.
[14]	赵欣, 马雪, 曲芳菲. 动态心电图在冠心病心律失常患者中的诊断效果[J]. 重庆医学, 2017,46(2):37-38.
[15]	张辉, 王茜. 瑞舒伐他汀对急性心肌梗死患者PCI术后血管内皮功能和炎性因子水平的影响[J]. 中国生化药物杂志, 2016,36(11):124-126.
[16]	沈正, 刘兴德, 韦波, 等. 血清超敏C反应蛋白对冠状动脉粥样硬化性心脏病PCI手术患者危险分层与评估预后的价值[J]. 重庆医学, 2018,27(1):54-56.
[17]	韩世华. 急性冠状动脉综合征患者CD40L、TNF-α、IL-6及hs-CRP水平与室性心律失常相关性研究[J]. 中国现代医药杂志, 2016,18(5):57-59.
[18]	Ascharsobbi R, Izaddoustdar F, Korogyi AS, et al. Increased atrial arrhythmia susceptibility induced by intense endurance exercise in mice requires TNFα[J]. Nat Commun, 2015,6:6018. doi: 10.1038/ncomms7018 URL
[19]	吴文波. 瑞舒伐他汀对急性脑梗死患者血浆炎症因子水平的影响[J]. 实用临床医药杂志, 2015,19(9):134-136.
[20]	许长青, 郭少敏, 刘春光等. 瑞舒伐他汀强化治疗对急性脑梗死患者颈动脉斑块及血清炎症细胞因子水平的影响[J]. 山东医药, 2020,60(17):61-63.
[21]	冯旭光. 大鼠心肌缺血再灌注损伤中氧自由基、心肌细胞凋亡和缺血再灌注性心律失常的相关性[J]. 中西医结合心血管病电子杂志, 2016,4(30):73-73.
[22]	Zani D, Dondi D, Araújo S, et al. Impact of γ-rays on seed germination/short-term storage in four native alpine species: Correlation with free radical and antioxidant profiles[J]. Radiation Physics & Chemistry, 2017,131:86-94.
[23]	韩雪, 马麟, 冯瑞华, 等. 瑞舒伐他汀联合胺碘酮对ACS伴心律失常的疗效分析[J]. 检验医学与临床, 2017,14(2):256-258.

组别	例数	显效	有效	无效	总有效率
对照组	55	30(54.55)	17(30.91)	8(14.55)	47(85.45)
观察组	55	34(61.82)	19(34.55)	2(3.64)	53(96.36)
χ²值		0.598	0.165	3.960	3.960
P值		0.439	0.684	0.047	0.047

组别	例数	显效	有效	无效	总有效率
对照组	55	30(54.55)	17(30.91)	8(14.55)	47(85.45)
观察组	55	34(61.82)	19(34.55)	2(3.64)	53(96.36)
χ²值		0.598	0.165	3.960	3.960
P值		0.439	0.684	0.047	0.047

组别	例数	SDNN(ms)		SDANN(ms)		RMSSD(ms)		pNN50(%)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	55	83.29±13.49	105.28±9.81^*	84.82±12.89	104.95±9.59^*	20.24±6.89	27.53±6.93^*	5.82±1.24	8.12±2.59^*
对照组	55	82.75±12.64	94.82±8.95^*	84.53±13.32	93.94±9.07^*	21.23±7.04	24.13±5.42^*	5.62±1.36	6.95±2.14^*
t值		0.217	5.842	0.116	6.186	0.745	2.866	0.806	2.583
P值		0.829	<0.01	0.907	<0.01	0.458	0.005	0.422	0.011

组别	例数	SDNN(ms)		SDANN(ms)		RMSSD(ms)		pNN50(%)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	55	83.29±13.49	105.28±9.81^*	84.82±12.89	104.95±9.59^*	20.24±6.89	27.53±6.93^*	5.82±1.24	8.12±2.59^*
对照组	55	82.75±12.64	94.82±8.95^*	84.53±13.32	93.94±9.07^*	21.23±7.04	24.13±5.42^*	5.62±1.36	6.95±2.14^*
t值		0.217	5.842	0.116	6.186	0.745	2.866	0.806	2.583
P值		0.829	<0.01	0.907	<0.01	0.458	0.005	0.422	0.011

组别	例数	hs-CRP(mg/L)		TNF-α(pg/ml)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	55	16.34±2.84	11.25±2.74^*	3.04±1.53	1.95±0.52^*
观察组	55	16.42±3.01	5.71±1.38^*	3.12±1.58	1.33±0.27^*
t值		0.431	13.392	0.270	7.848
P值		0.886	0.000	0.788	0.000