【摘要】 目的 報道1例靜脈滴注胺碘酮致肝腎功能不全患者。 方法 2010年10月收治1例擴張性心肌病患者，治療過程中使用胺碘酮注射液，導致嚴重的肝腎功能不全。系統查閱中國期刊全文數據庫及外文數據庫Pubmed、Embase建庫至2011年8月關于胺碘酮致肝腎功能不全的相關文獻，進行靜脈胺碘酮致肝腎功能不全的可能性評估，探索胺碘酮靜脈滴注致肝功能不全的的作用機制。 結果 根據查閱文獻結果分析，此患者靜脈注射胺碘酮致肝功不全的可能性高，Naranjo概率評分分別為7分。 結論 提出臨床醫師和臨床藥師應進行胺碘酮靜脈的藥學監護，高度的重視胺碘酮相關的不良反應，從而及時識別和防治胺碘酮所致肝腎功能不全，減少其不良預后。【Abstract】 Objective To report a case of hepatic and renal insufficiency induced by intravenous injection with amiodarone, and to evaluate the possibility of the adverse drug reaction. Methods A patient with dilated cardiomyopathy was admitted in October, 2010. During the procedure, the use of amiodarone hydrochloride injection made the patient suffer from liver and kidney dysfunction. We retrieved the literatures about liver and kidney toxicity of amiodarone from CNKI, Pubmed, and Embase (from the establishment of the databases to November 2011). We also ssessed the possibility of the adverse drug reaction, discussed the mechanism of amiodarone-induced hepatic insufficiency. Results According to the literature, There was a great possibility of hepatic insufficiency induced by amiodarone, and the total score of the Naranjo probability score was 7. Conclusion It is important to pay more attention to the pharmaceutical care of amidarone to timely recognize and effectively prevent or treat hepatic and renal insufficiency induced by intravenous injection with amiodarone.
Objective To evaluate the therapeutic effectiveness and safety of ibutilide versus amiodarone in the treatment of atrial fibrillation and atrial flutter. Methods An electronic search in databases including PubMed, Embase, CNKI, WanFang Data, VIP Database, and The Cochrane Library (Issue 2, 2011), published from January 1994 to January 2011,was conducted to include both English and Chinese randomized controlled trials (RCTs) about ibutilide versus amiodarone in treating atrial fibrillation and atrial flutter. Two reviewers independently screened the studies according to the inclusive and exclusive criteria, extracted the data, assessed the methodological quality, and then performed Meta-analysis by using RevMan 5.0 software. Results Eight RCTs involving 506 patients were finally included. The results of Meta-analysis showed: a) The total effective rate of alleviating atrial fibrillation and atrial flutter in the ibutilide group was superior to that of the amiodarone group (OR=2.27, 95%CI 1.19 to 4.33, P=0.01); b) Four RCTs showed that ibutilide was similar to amiodarone for alleviating atrial fibrillation (OR=1.61, 95%CI 0.96 to 2.71, P=0.07), but the former was superior to the latter for alleviating atrial flutter (OR=8.97, 95%CI 4.51 to 17.84, Plt;0.000 01); c) Five RCTs showed that ibulitide took shorter time to alleviate atrial fibrillation and atrial flutter compared with amiodarone (WMD= –126.55 min, 95%CI –202.35 to –50.76, P=0.001); d) Four RCTs showed that the total adverse effect rates in the two groups had no significant difference (OR=1.13, 95%CI 0.37 to 3.43, P=0.83), but there were more cardiovascular side-effects in the ibutilide group (OR=2.36, 95%CI 1.40 to 4.01, P=0.001). Conclusion Compared with amiodarone, ibutilide has a higher total effective rate in cardioversion of atrial fibrillation and atrial flutter, and it obviously takes shorter time to alleviate atrial fibrillation and atrial flutter, but there is no significant difference in the cardioversion rate of atrial fibrillation between them. There is no significant difference in total side-effect rates between the two groups, but the cardiovascular adverse reaction in the ibutilide group is significantly higher than that of the amiodarone group. Because of the limited quantity and quality of the included studies, this conclusion has to be further proved by more high-quality RCTs.
ObjectiveTo systematically review the efficacy of irbesartan combined with amiodarone versus amiodarone alone for paroxysmal atrial fibrillation. MethodsWe electronically searched databases including PubMed, CENTRAL, EMbase, VIP, CNKI and WanFang Data to collect randomized controlled trials (RCTs) about irbesartan combined with amiodarone versus amiodarone alone in the treatment of paroxysmal atrial fibrillation from 2000 to 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of nine studies involving 998 patients were included. The results of meta-analysis showed that:Compared with the amiodarone group, the left atrial diameter was smaller (MD=-1.49, 95% CI -1.82 to -1.15), and the maintenance rates of sinus rhythm were higher (OR=3.02, 95%CI 2.21 to 4.11) in the irbesartan plus amiodarone group after 12 months. ConclusionCurrent evidence indicates that the combination treatment of irbesartan and amiodarone for paroxysmal atrial fibrillation is better than amiodarone alone in delaying the enlargement of left atrial diameter, as well as the maintenance of sinus rhythm. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically evaluate the pharmacoeconomic value of radiofrequency ablation (RFA) versus amiodarone in the treatment of atrial fibrillation (AF), and to provide reference for treatment scheme selection, drug selection and the formulation of drug policy. MethodsWe searched databases including PubMed, The Cochrane Library, CNKI and CBM from 2000 to 2014 to collect pharmacoeconomic studies on RFA versus Amiodarone for treating AF. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. The cost-effectiveness of RFA and Amiodarone for AF was compared according to the cost, effectiveness, and incremental cost-effectiveness ratio (ICER). ResultsA total of three studies were included. The results of pharmacoeconomic evaluation showed that the ICERs for each study were $7 976 to $29 068, ￡7 763 to ￡27 745, and $59 194, respectively. According to country-specific willingness to pay thresholds, the ICER of each included study was acceptable. ConclusionCompared to Amiodarone, RFA is a cost-effective therapy for AF.
Objective To evaluate the efficacy and safety of Shen Song Yang Xin Capsule for cardiac arrhythmia. Methods Randomized controlled trials (RCTs) were searched from the following electronic databases: WanFang, CNKI, CBM, VIP, PubMed, and The Cochrane Library. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using RevMan 5.0 software. Results Thirteen studies involving 1896 participants were included. The results of meta-analyses showed that compared with the control group, a) efficacy: Shen Song Yang Xin Capsule was superior to mexiletine (OR=2.96, 95%CI 1.79 to 4.87), and propafenone (OR=2.41, 95%CI 1.60 to 3.62), but was not superior to miodarone (OR=1.25, 95%CI 0.88 to 1.71); b) safety: Shen Song Yang Xin Capsule was superior to propafenone and miodarone in reducing the incidence of cardiac arrhythmia (OR=0.06, 95%CI 0.01 to 0.35; OR=0.05, 95%CI 0.02 to 0.17), but no significant difference was found between the two groups in incidence of gastrointestinal adverse reactions. Conclusion Based on the current studies, Shen Song Yang Xin Capsule is not inferior to the commonly-used anti-arrhythmic medicine at present. It has lower incidence of cardiac arrhythmia, and has no significant difference in the incidence of gastrointestinal adverse reactions compared with western drugs. For the quality restrictions of the included studies, more double blind RCTs with high quality are required to further assess the effects.
摘要:目的:探討胺碘酮治療充血性心力衰竭(CHF)心房顫動伴快速心室率的臨床療效。方法: 將106例各種原因所致的房顫伴快速心室率的CHF患者按入院順序隨機分為治療組及對照組。兩組抗CHF基礎治療相同,治療組加用靜脈負荷量胺碘酮150 mg后,再以1 000μg/min靜脈點滴維持6小時,500 μg/min靜滴18小時。同時口服胺碘酮0.2,3次/d,1周;再0.2,2次/d,1周以后以0.2,1次/d 至觀察終點,隨診為12個月。 結果: 治療組53例使用胺碘酮治療可顯著增加抗心律失常有效性,改善左室射血分數,減少心力衰竭再住院率,42例患者轉復為室性心律。 結論: 靜脈及口服胺碘酮同時應用治療充血性心力衰竭房顫是有效和安全的。Abstract: Objective: To explore the effect and safety of amiodarone in the treatment of atrial fibrillation with congestive heart failure. Methods:One hundred and six patients of AF with CHF caused by a variety of reasons were randomly divided into treatment group and control group according to hospitalized order.The two groups were treated with the same antiCHF therapy,the treatment group was treated with loaded intravenous amiodarone 150 mg;and then dripped to 1 000 μg/min for 6 hours, dripped to 500 μg/min for 18 hours. United with oral amiodarone by amiodarone tablets with 0.2 g,3 time/day a week,further 0.2 g,2 times/day a week,later 0.2 g,1 times/day to the end.The end of followup time was 12 months. Results:In treatment group,53 cases with amiodarone therapy can significantly increase the effectives of antiarrhythmic, improve the rate and heart failure rehospitalization.42/53 patients reversed to sinus rhythm. Conclusion:The results showed it is effective and safe united with intravenous amiodarone and oral amiodarone in treatment of atrial fibrillation with organic heart disease.
目的:研究猝死患者在心肺復蘇過程中出現室性心率失常時胺碘酮的應用。方法:選心肺復蘇過程中出現的室性心律失常患者共107例,隨機分為治療組57例采用胺碘酮治療,對照組50例采用利多卡因治療,持續心電監護觀察其療效。結果:治療組、對照組有效率分別為93.1%、80.0%,有顯著性差異。結論:胺碘酮組的療效明顯高于利多卡因組,在治療心肺復蘇過程中室性心律失常應首選胺碘酮。
Objective To evaluate efficacy of amiodarone in the prevention of atrial fibrillation after coronary artery bypass grafting. Methods CBM (from January 1978 to August 2017), CNKI (from January 1987 to August 2017), VIP (from January 1989 to August 2017), Wanfang (from January 1998 to August 2017) and PubMed (from January 1989 to August 2017) databases were searched. The articles were selected based on the inclusion and exclusion criteria. Quality of articles was assessed by improved Jadad scale. Statistical analysis was performed using RevMan 5.3. Results There were 19 articles meeting inclusion criteria including 2 817 patients and all were randomized controlled trial (RCT). There were 16 articles with high quality and 3 articles with low quality by improved Jadad scale. Compared with the placebo, amiodarone had a significant effect on reducing the incidence of atrial fibrillation after coronary artery bypass grafting (RR=0.37, 95% CI 0.28 to 0.50, P<0.000 01) and different administration models and time of amiodarone had effect on the atrial fibrillation after aterial bypass grafting (P<0.05). Conclusion Compared with the placebo, amiodarone is effective in reducing the incidence of atrial fibrillation after coronary artery bypass grafting.