目的 探讨伊布利特联合阿托伐他汀对冠状动脉搭桥围术期房颤的预防作用。方法 回顾性分析2020年1月—2020年12月在安徽省立医院接受治疗的148例施行冠状动脉搭桥术的冠心病患者，根据不同治疗方式分为对照组（n＝73）和试验组（n＝75）。两组患者施行冠状动脉搭桥术后均常规给予阿司匹林、酒石酸美托洛尔等常规药物治疗。对照组术前7 d及术后第2天给予阿托伐他汀钙片口服，每次20 mg，每晚1次。试验组在对照组的基础上于术后第2天加用富马酸伊布利特注射液，1 mg加0.9%氯化钠注射液20 mL，10 min内静脉推注给药。静推过程中若患者转为窦性心律，则停止推注。静推后10 min若患者仍未转复为窦性心律，则间隔30 min再次给予富马酸伊布利特注射液1 mg，若仍房颤，则镇静后，给予200 J同步直流电复律。两组术后均常规抗凝，疗程7 d。术后7 d比较两组患者的临床疗效、术后房颤发生情况，分别于给药前、第1次给药后30 min及第1次给药后24 h测定患者左心房内径、血清肌钙蛋白I（CTnI）、P波离散度，观察治疗期间两组患者不良反应发生情况。结果 治疗后，试验组总有效率为93.33%，显著高于对照组的73.97%，两组比较差异有统计学意义（P<0.05）。两组术后房颤起始时间比较差异无统计学意义（P>0.05）；试验组最大心室率、单次房颤持续时间均显著低于对照组，差异有统计学意义（P<0.05）。治疗前，两组左心房内径、CTnI水平比较差异无统计学意义（P>0.05）；第1次给药后30 min，两组左心房内径、CTnI水平均显著升高（P<0.05），但两组左心房内径、CTnI水平比较差异无统计学意义（P>0.05）；第1次给药后24 h，两组左心房内径、CTnI水平均低于治疗前（P<0.05），试验组恢复程度优于对照组，差异有统计学意义（P<0.05）。治疗前，两组P波最大值、P波宽度水平比较差异无统计学意义（P>0.05）；第1次给药后30 min，两组P波最大值、P波宽度水平均显著升高（P<0.05），但两组P波最大值、P波宽度水平比较差异无统计学意义（P>0.05）；第1次给药后24 h，两组P波最大值、P波宽度水平均低于治疗前（P<0.05），试验组恢复效果优于对照组，差异有统计学意义（P<0.05）。两组用药期间不良反应发生情况差异无统计学意义（P>0.05）。结论 伊布利特联合阿托伐他汀可有效预防冠脉搭桥术后房颤的发生，可有效控制心房内径增大，延缓心肌重构。

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

安徽省自然科学基金面上项目（2008085MH240）