摘要
目的 对心肌梗死急性期并发反复发作恶性室性心律失常，在应用利多卡因抗心律失常药物后仍无效或电复律后再次复发者，改为静脉应用胺碘酮转复的临床观察。方法 对所选病例，静脉注射胺碘酮150-300mg（3～5mg／kg）加生理盐水20ml稀释后10min内注入，若心律失常未控制，10～15min后重复追加注射1次（150mg／次），本文中24h内最多追加4次。静脉注射负荷量后，以1mg／min静滴维持6h，随后以0．5mg／min静脉微量泵静滴维持，在静脉用药的同时口服胺碘酮（起始720mg／d，1周后改口服600mg／d，2周后改200mg／d维持。）结果 6例4h内控制；14例24h内控制；5例48h内控制；2例72h内控制；6例反复电击2～4次，用药后1周内得到控制；8例死亡。总有效率33／41（80．5％）。结论 急性心肌梗死并发恶性室性心律失常时，临床上首选电复律，但经电复律后仍反复有恶性室性心律失常发作时，静脉应用胺碘酮转复较利多卡因更为有效且未见严重不良反应。
Objective To evaluate the effect of Amiodarone treating patients who had repeated occurrence of malignant ventricular arrhythmia from acute myocardial infarction and failed to response to lidocaine or electrical cardioversion. Methods Treated the selected patients with amiodarone 150- 300 mg （3- 5 mg/min） by infusion; repeated 150 mg every 10 to 15 min as needed with maximal four injections in 24 hours. If cardioversion was successful, infused 1 mg/min over 6 hours, then 0.5 mg/min to maintain. At the same time, took amiodarone orally begining with 720 mg per day , then 600 mg per day one week later, and 200 mg per day two weeks later to maintain sinus heart rate. Results 6 patients got controlled in 4 hours, 14 patients in 24 hours, 5 patients in 48 hours, 2 patients in 72 hours; treated 6 patients with electronic shock 2 - 4 times, and got controlled in 1 week and 8 died. The total cardioversion rate was 33/41 （80.5 % ）. Conclusion Electrical cardioversion is often used as the first choice to treat patients with malignant ventricular arrhythrnia after acute myocardial infarction; if unsuccessful, use arniodarone intravenously is more effective and has less serious complications than lidocaine.
出处
《同济大学学报（医学版）》
CAS
2006年第4期64-67,共4页
Journal of Tongji University(Medical Science)
关键词
胺碘酮
急性心肌梗死
室性心律失常
利多卡因
amiodarone
acute myocardial infarction
ventricular arrhythmia
lidocaine
