作者：米勒之声
危重症成人患者新发房颤的管理：一个系统回顾和综述
贵州医科大学 麻醉与心脏电生理课题组
翻 译：胡廷菊 编 辑：柏雪 审 校：曹莹
背景：新发心房颤动（NOAF）是影响危重症患者最常见的心律失常。NOAF可导致血流动力学恶化、心力衰竭、血栓栓塞事件和死亡率增加。本系统回顾和综述的目的是评估危重症患者NOAF的非药理学和药理学管理策略。 方法：在1782项研究中，30项符合纳入条件，包括4项RCT和26项观察性研究。本文报道了直流电转复、胺碘酮、β-肾上腺素能受体拮抗剂、钙通道阻滞剂、地高辛、镁以及较不常用的药物如伊布利特的疗效。 结果：直流电律转复率为48%；然而，NOAF的发生率高达23.4%。胺碘酮是最常见的干预方法，转复率为18%-96%，其次是β-拮抗剂，转复率为40%-92%。胺碘酮在转复时比地尔硫卓有效（优势比[OR]=1.91，P=0.32）。短效β拮抗剂艾司洛尔和兰地洛尔在心脏转复（OR=3.55，P=0.04）和HR控制（OR=3.2，P<0.001）方面更有效。
结论：在成功转复和心率控制的定义方面，不同研究之间存在显著差异，这使得研究和干预之间的比较变得困难。未来需要进行比较个别抗心律失常药物，特别是镁、胺碘酮和β拮抗剂的随机对照试验，以及研究抗凝在危重患者中的作用。我们还迫切需要一个核心结果数据集来研究新发性房颤，以便比较不同的抗心律失常策略。
原始文献来源：Johnston BW, Chean CS, Duarte R, Hill R, Blackwood B, McAuley DF, Welters ID. Management of new onset atrial fibrillation in critically unwell adult patients: a systematic review and narrative synthesis. Br J Anaesth. 2022 May;128(5):759-771. doi: 10.1016/j.bja.2021.11.016. Epub 2021 Dec 13. PMID: 34916053.
英文原文：
Management of new onset atrial fibrillation in critically unwell adult patients: a systematic review and narrative synthesis
Abstract
Background: New onset atrial fibrillation (NOAF) is the most common arrhythmia affecting critically unwell patients. NOAF can lead to worsening haemodynamic compromise, heart failure, thromboembolic events, and increased mortality. The aim of this systematic review and narrative synthesis is to evaluate the non-pharmacological and pharmacological management strategies for NOAF in critically unwell patients.
Methods: Of 1782 studies, 30 were eligible for inclusion, including 4 RCTs and 26 observational studies. Efficacy of direct current cardioversion, amiodarone, b-adrenergic receptor antagonists, calcium channel blockers, digoxin, magnesium, and less commonly used agents such as ibutilide are reported.
Results:Cardioversion rates of 48% were reported for direct current cardioversion; however, re-initiation of NOAF was as high as 23.4%. Amiodarone was the most commonly reported intervention with cardioversion rates ranging from 18% to 96% followed by b-antagonists with cardioversion rates from 40% to 92%. Amiodarone was more effective than diltiazem (odds ratio [OR]=1.91, P=0.32) at cardioversion. Short-acting b-antagonists esmolol and landiolol were more effective compared with diltiazem for cardioversion (OR=3.55, P=0.04) and HR control (OR=3.2, P<0.001).
Conclusions:There was significant variation between studies with regard to the definition of successful cardioversion and heart rate control, making comparisons between studies and interventions difficult. Future RCTs comparing individual anti-arrhythmic agents, in particular magnesium, amiodarone, and b-antagonists, and studying the role of anticoagulation in critically unwell patients are required. There is also an urgent need for a core outcome dataset for studies of new onset atrial fibrillation to allow comparisons between different anti-arrhythmic strategies.
免责声明：
文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。
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编辑：MiSuper.米超
校对：Michel.米萱
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