Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Czechia.
Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Czechia.
J Crit Care. 2017 Oct;41:16-23. doi: 10.1016/j.jcrc.2017.04.027. Epub 2017 Apr 26.
The occurence of supraventricular arrhythmias associate with an unfavourable prognosis in septic shock. Propafenone could be a feasible antiarrhythmic.
Patients collected over a period of 24months were divided into the three groups based on antiarrhythmic: Group1(amiodarone), Group2(propafenone), Group3(metoprolol). Type of arrhythmia, cardioversion rates, demographic, haemodynamic, laboratory parameters were recorded in the first 24h. The outcome data were compared between the groups.
234 patients (99.1% ventilated) were included, the prevailing arrhythmia was acute onset atrial fibrillation (AF,69.7%). Except for the dosage of noradrenaline (0.35(0.14-0.78) in Group1(n=142)vs 0.25(0.10-0.50),p<0.01 in Group2(n=78)vs 0.14(0.07-0.25)μg/kg·min,p<0.05 in Group3(n=14)) the ejection fraction of left ventricle, rates of renal replacement therapy, arterial lactate and procalcitonin levels were not different between the groups. The cardioversion rate in Group1(74%) was lower than in Group2(89%) and Group3(92%). ICU and 28-day mortalities of Group1 were not significantly higher than in Group2 and Group3. Multivariate analysis demonstrated higher 12-month mortality in Group1 than in Group2 (HR1.58(1.04;2.38),p=0.03).
Propafenone demonstrated a higher cardioversion rate than amiodarone with a similar impact on the outcome. Patients remaining in acute onset arrhythmia did not demonstrate significantly higher ICU, 28-day and 12-month mortalities compared to those successfully cardioverted or to those having chronic AF.
室上性心律失常的发生与脓毒性休克的不良预后相关。普罗帕酮可能是一种可行的抗心律失常药物。
在 24 个月的时间内收集的患者根据抗心律失常药物分为三组：组 1（胺碘酮）、组 2（普罗帕酮）、组 3（美托洛尔）。在最初的 24 小时内记录心律失常类型、电复律率、人口统计学、血流动力学、实验室参数。比较组间的结局数据。
共纳入 234 例（99.1%接受机械通气）患者，主要心律失常为急性发作心房颤动（AF，69.7%）。除去甲肾上腺素剂量外（组 1（n=142）为 0.35（0.14-0.78），组 2（n=78）为 0.25（0.10-0.50），组 3（n=14）为 0.14（0.07-0.25）μg/kg·min，p<0.05），左心室射血分数、肾脏替代治疗率、动脉血乳酸和降钙素原水平在各组之间无差异。组 1（74%）的电复律率低于组 2（89%）和组 3（92%）。组 1 的 ICU 和 28 天死亡率与组 2 和组 3 无显著差异。多变量分析显示，与组 2 相比，组 1 的 12 个月死亡率更高（HR 1.58（1.04；2.38），p=0.03）。
普罗帕酮的电复律率高于胺碘酮，对结局的影响相似。与成功电复律或持续存在慢性 AF 的患者相比，仍处于急性发作心律失常的患者的 ICU、28 天和 12 个月死亡率并未显著升高。
