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最新消息| 文獻導讀||胺碘酮加或不加N-乙酰半胱氨酸預防胸部手術后心房顫動 | 2022-07-12 |
| 文章来源：由「百度新聞」平台非商業用途取用"https://new.qq.com/omn/20220312/20220312A093QL00.html" 摘要譯文（供參考）胺碘酮加或不加N-乙酰半胱氨酸預防胸部手術后心房顫動：一項雙盲隨機試驗背景：術后心房顫動（AF）可能會識別出繼發于AF風險的患者，其卒中風險更大。我們假設N-乙酰半胱氨酸可以減輕炎癥和氧化應激，從而降低術后房顫的發生率。方法：在這項雙盲安慰劑對照試驗中，擇期接受胸部大手術的術后房顫高危患者被隨機分為N-乙酰半胱氨酸加胺碘酮組或安慰劑加胺碘酮組。到達麻醉復蘇室（PACU）后，給予N-乙酰半胱氨酸或安慰劑（靜脈注射50mgkg，然后50mgkg24hx48h）加胺碘酮（靜脈注射150mg，然后1g24hx48h）。主要轉歸是前72小時自動測量出現房顫持續時間大于30秒，或術后七天內出現需要干預和通過心電圖確認的癥狀。術后立即和術后第2天評估全身炎癥標志物（白細胞介素-6、白細胞介素-8、腫瘤壞死因子-α、C-反應蛋白）和氧化應激（F2-異前列腺素PGF2α[8-iso-PGF2α]，isofuran）。每月給患者打電話，評估第一年房顫的發生情況。結果：在納入的154名患者中，78名接受N-乙酰半胱氨酸治療的患者中有15名發生術后房顫（19%），76名接受安慰劑治療的患者中有13名發生術后房顫（17%）（優勢比為1.24；95.1%可信區間為0.53-2.88；p=0.615）。由于無效，試驗在中期分析時停止。28例術后房顫患者中有3例（11%）在房顫期間出院。無論1年后接受何種治療，28例術后房顫患者中有7例（25%）出現房顫復發。兩組間炎癥和氧化應激標記物相似。結論：與單用胺碘酮相比，包括N-乙酰半胱氨酸和胺碘酮的雙重治療并不能降低胸部大手術后早期的術后房顫發生率或炎癥和氧化應激標志物。在胸部大手術后1年內發生術后房顫的患者中，房顫復發很常見。原文摘要AmiodaroneWithorWithoutN-acetylcysteineforthePreventionofAtrialFibrillationAfterThoracicSurgery:ADouble-Blind,RandomizedTrialPostoperativeatrialfibrillation(AF)mayidentifypatientsatriskofsubsequentAF,withitsgreaterriskofstroke.WehypothesizedthatN-acetylcysteinemitigatesinflammationandoxidativestresstoreducetheincidenceofpostoperativeAF.Background:Methods:Inthisdouble-blind,placebo-controlledtrial,patientsathighriskofpostoperativeAFscheduledtoundergomajorthoracicsurgerywererandomizedtoN-acetylcysteineplusamiodaroneorplaceboplusamiodarone.Onarrivaltothepostanesthesiacareunit,N-acetylcysteineorplacebobolus(intravenous50mgkgthen50mgkg24hx48h)wasadministeredplusamiodarone(intravenous150mgthen1g24hx48h).TheprimaryoutcomewassustainedAF30sbytelemetry(first72h)orsymptomsrequiringinterventionandconfirmedbyECGwithin7daysofsurgery.Systemicmarkersofinflammation(interleukin-6,interleukin-8,tumornecrosisfactor-α,C-reactiveprotein)andoxidativestress(F2-isoprostaneprostaglandinPGF2α[8-iso-PGF2α],isofuran)wereassessedimmediatelyaftersurgeryandonpostoperativeday2.PatientswerephonedmonthlytoassesstheoccurrenceofAFinyear1.Results:Among154patientsincluded,postoperativeAFoccurredin15of78whoreceivedN-acetylcysteine(19%)and13of76whoreceivedplacebo(17%)(oddsratio,1.24;95.1%confidenceinterval,0.53-2.88;p=0.615).Thetrialwasstoppedattheinterimanalysisbecauseoffutility.Threeofthe28patientswithpostoperativeAF(11%)weredischargedinAF.Regardlessoftreatmentat1year,7of28patientswithpostoperativeAF(25%)hadrecurrentepisodesofAF.Inflammatoryandoxidativestressmarkersweresimilarbetweengroups.Conclusions:DualtherapycomprisingN-acetylcysteineplusamiodaronedidnotreducetheincidenceofpostoperativeAFormarkersofinflammationandoxidativestressearlyaftermajorthoracicsurgery,comparedwithamiodaronealone.RecurrentAFepisodesarecommonamongpatientswithpostoperativeAFwithin1yearofmajorthoracicsurgery. 關鍵字標籤：眼袋手術 |
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