DiDomenico Robert J, Massad Malek G
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Ann Thorac Surg. 2005 Feb;79(2):728-40. doi: 10.1016/j.athoracsur.2004.03.037.
Postoperative atrial fibrillation is a common complication after open heart surgery; it increases morbidity, hospital stay, and costs. In an analysis of 8 large cardiac surgery trials totaling 20,193 patients, the incidence of postoperative atrial fibrillation was estimated to be 26% and ranged from 17% to 35%. We reviewed the results of 52 studies published between 1966 and 2003 that evaluated pharmacologic strategies to prevent postoperative atrial fibrillation in nearly 10,000 patients undergoing open heart operations. Supraventricular tachyarrhythmias, including atrial fibrillation, after open heart operations occurred in 29% of patients who did not receive prophylactic drugs, compared with 12% in patients who received intravenous followed by oral amiodarone, 15% in those given sotalol, 16% in those given oral amiodarone, and 19% in those given beta-blockers. Pharmacologic strategies and regimens aimed at preventing postoperative atrial fibrillation are necessary to optimize the postoperative care of patients undergoing open heart operations. Although no strategy has consistently been shown to be superior to another, the most effective approach to preventing postoperative atrial fibrillation likely involves multiple interventions. In the absence of contraindications, all patients should receive beta-blocker therapy before and after the operation. For patients with 1 or more risk factors for postoperative atrial fibrillation, regimens consisting of either sotalol (beta-blocker with class III antiarrhythmic properties) alone or beta-blockers in combination with amiodarone seem to be the safest, most effective pharmacologic strategies for preventing postoperative atrial fibrillation.
术后房颤是心脏直视手术后常见的并发症；它会增加发病率、住院时间和费用。在一项对总计20193例患者的8项大型心脏手术试验的分析中，术后房颤的发生率估计为26%，范围在17%至35%之间。我们回顾了1966年至2003年间发表的52项研究的结果，这些研究评估了在近10000例接受心脏直视手术的患者中预防术后房颤的药物策略。未接受预防性药物治疗的患者中，29%发生了包括房颤在内的室上性快速心律失常，而接受静脉注射后口服胺碘酮的患者中这一比例为12%，服用索他洛尔的患者中为15%，口服胺碘酮的患者中为16%，服用β受体阻滞剂的患者中为19%。旨在预防术后房颤的药物策略和方案对于优化心脏直视手术患者的术后护理是必要的。尽管没有一种策略一直被证明优于另一种，但预防术后房颤最有效的方法可能涉及多种干预措施。在没有禁忌证的情况下，所有患者在手术前后都应接受β受体阻滞剂治疗。对于有1个或更多术后房颤危险因素的患者，单独使用索他洛尔（具有III类抗心律失常特性的β受体阻滞剂）或β受体阻滞剂与胺碘酮联合使用的方案似乎是预防术后房颤最安全、最有效的药物策略。
