目的 探討伊布利特聯(lián)合阿托伐他汀對冠狀動脈搭橋圍術期房顫的預防作用。方法 回顧性分析2020年1月—2020年12月在安徽省立醫(yī)院接受治療的148例施行冠狀動脈搭橋術的冠心病患者，根據(jù)不同治療方式分為對照組（n＝73）和試驗組（n＝75）。兩組患者施行冠狀動脈搭橋術后均常規(guī)給予阿司匹林、酒石酸美托洛爾等常規(guī)藥物治療。對照組術前7 d及術后第2天給予阿托伐他汀鈣片口服，每次20 mg，每晚1次。試驗組在對照組的基礎上于術后第2天加用富馬酸伊布利特注射液，1 mg加0.9%氯化鈉注射液20 mL，10 min內靜脈推注給藥。靜推過程中若患者轉為竇性心律，則停止推注。靜推后10 min若患者仍未轉復為竇性心律，則間隔30 min再次給予富馬酸伊布利特注射液1 mg，若仍房顫，則鎮(zhèn)靜后，給予200 J同步直流電復律。兩組術后均常規(guī)抗凝，療程7 d。術后7 d比較兩組患者的臨床療效、術后房顫發(fā)生情況，分別于給藥前、第1次給藥后30 min及第1次給藥后24 h測定患者左心房內徑、血清肌鈣蛋白I（CTnI）、P波離散度，觀察治療期間兩組患者不良反應發(fā)生情況。結果 治療后，試驗組總有效率為93.33%，顯著高于對照組的73.97%，兩組比較差異有統(tǒng)計學意義（P<0.05）。兩組術后房顫起始時間比較差異無統(tǒng)計學意義（P>0.05）；試驗組最大心室率、單次房顫持續(xù)時間均顯著低于對照組，差異有統(tǒng)計學意義（P<0.05）。治療前，兩組左心房內徑、CTnI水平比較差異無統(tǒng)計學意義（P>0.05）；第1次給藥后30 min，兩組左心房內徑、CTnI水平均顯著升高（P<0.05），但兩組左心房內徑、CTnI水平比較差異無統(tǒng)計學意義（P>0.05）；第1次給藥后24 h，兩組左心房內徑、CTnI水平均低于治療前（P<0.05），試驗組恢復程度優(yōu)于對照組，差異有統(tǒng)計學意義（P<0.05）。治療前，兩組P波最大值、P波寬度水平比較差異無統(tǒng)計學意義（P>0.05）；第1次給藥后30 min，兩組P波最大值、P波寬度水平均顯著升高（P<0.05），但兩組P波最大值、P波寬度水平比較差異無統(tǒng)計學意義（P>0.05）；第1次給藥后24 h，兩組P波最大值、P波寬度水平均低于治療前（P<0.05），試驗組恢復效果優(yōu)于對照組，差異有統(tǒng)計學意義（P<0.05）。兩組用藥期間不良反應發(fā)生情況差異無統(tǒng)計學意義（P>0.05）。結論 伊布利特聯(lián)合阿托伐他汀可有效預防冠脈搭橋術后房顫的發(fā)生，可有效控制心房內徑增大，延緩心肌重構。

Objective To investigate the preventive effect of ibutilide combined with atorvastatin on atrial fibrillation during perioperative period of coronary artery bypass grafting. Methods A retrospective analysis was performed on 148 patients with coronary heart disease who received coronary artery bypass grafting in Anhui Provincial Hospital from January 2020 to December 2020. According to different treatment methods, the patients were divided into control group (n=73) and experimental group (n=75). Patients in both groups were routinely given aspirin, metoprolol tartrate and other conventional drugs after coronary artery bypass grafting. The control group was given Atorvastatin Calcium Tablets orally, 20 mg each time, once a night, 7 days before surgery and 2 days after surgery. On the basis of the control group, the experimental group was additionally given Ibutilide Fumarate Injection, 1 mg plus 0.9% Sodium Chloride Injection 20 mL, intravenously within 10 min. If the patient changes to sinus rhythm during static pushing, the injection is stopped. After 10 min of static delay, if the patient still did not revert to sinus rhythm, Ibutilide Fumarate Injection 1 mg was given again 30 min later. If the patient still had atrial fibrillation, synchronous dc cardioversion was given 200 J after sedation. Conventional anticoagulation was performed in both groups. The clinical efficacy and incidence of postoperative atrial fibrillation were compared between the two groups. The left atrial inner diameter, serum troponin I (CTnI) and P wave dispersion were measured before administration, 30 min after the first administration and 24 h after the first administration, respectively, and the incidence of adverse reactions in the two groups during treatment was observed. Results After treatment, the total effective rate of the experimental group was 93.33%, significantly higher than 73.97% of the control group. There was significant difference between two groups (P<0.05). There was no significant difference in the onset time of atrial fibrillation between two groups (P > 0.05). The maximum ventricular rate and duration of single atrial fibrillation in the experimental group were significantly lower than those in control group (P<0.05). Before treatment, there was no significant difference in left atrial diameter and cTnI level between two groups (P > 0.05). 30 minutes after the first administration, the left atrial diameter and cTnI level were significantly increased in two groups (P<0.05), but there was no significant difference in the left atrial diameter and cTnI level between two groups (P > 0.05). 24 hours after the first administration, the left atrial diameter and cTnI level in two groups were lower than those before treatment (P<0.05), and the recovery degree in the experimental group was better than that in control group (P<0.05). Before treatment, there was no significant difference in P wave maximum and P wave width between two groups (P > 0.05). 30 minutes after the first administration, the maximum value and width of P wave in two groups were significantly increased (P<0.05), but there was no significant difference between two groups (P > 0.05). At 24 hours after the first administration, the maximum value and width of P wave in two groups were lower than those before treatment (P<0.05). The recovery effect of the experimental group was better than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in adverse reactions between two groups (P > 0.05). Conclusion Ibutilide combined with atorvastatin can effectively prevent atrial fibrillation after coronary artery bypass grafting, effectively control the increase of atrial diameter and delay myocardial remodeling.

R972

安徽省自然科學基金面上項目（2008085MH240）