Zebis Lars R, Christensen Thomas D, Kristiansen Ivar S, Hjortdal Vibeke E
Department of Cardiothoracic and Vascular Surgery, and Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark.
Ann Thorac Surg. 2008 Jan;85(1):28-32. doi: 10.1016/j.athoracsur.2007.07.060.
The purpose of this study was to estimate the costs and health benefits of routinely administered postoperative amiodarone as prevention of atrial fibrillation for patients undergoing coronary artery bypass grafting (CABG) for stable angina.
This cost-effectiveness study was based on a randomized, controlled, double-blind trial (the RASCABG study) using avoidance of atrial fibrillation as the measure of benefit at the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. Two hundred and fifty eligible consecutively enrolled CABG patients were included to receive either 300 mg amiodarone or placebo (5% aqueous dextrose solution) administered intravenously over 20 minutes followed by 600 mg amiodarone/placebo orally twice a day (8 am and 8 pm) for the first 5 postoperative days.
In the amiodarone group, there were 14 cases of atrial fibrillation compared with 32 in the control group (p < 0.01) whereas there were no differences in the length of stay. The mean total cost per patient was 7,639 euros in the amiodarone group and 7,814 euros in the placebo group (p < 0.01).
Routine use of postoperative prophylactic intravenous bolus and subsequent 5 days of oral amiodarone therapy after coronary artery bypass grafting reduces the risk of atrial fibrillation and decreases the total costs of care by 175 euros per patient.
本研究旨在评估对于因稳定型心绞痛接受冠状动脉旁路移植术（CABG）的患者，常规术后使用胺碘酮预防房颤的成本和健康效益。
这项成本效益研究基于一项随机、对照、双盲试验（RASCABG研究），以避免房颤作为效益衡量指标，该试验在丹麦斯凯比市奥胡斯大学医院心胸血管外科进行。连续纳入250例符合条件的CABG患者，分别接受20分钟内静脉注射300mg胺碘酮或安慰剂（5%葡萄糖水溶液），随后在术后第1至5天每天口服两次600mg胺碘酮/安慰剂（上午8点和晚上8点）。
胺碘酮组有14例房颤，而对照组有32例（p<0.01），但住院时间无差异。胺碘酮组每位患者的平均总成本为7639欧元，安慰剂组为7814欧元（p<0.01）。
冠状动脉旁路移植术后常规使用预防性静脉推注胺碘酮及随后5天的口服治疗可降低房颤风险，并使每位患者的护理总成本降低175欧元。
