摘要
目的探讨心脏起搏器联合β-阻滞剂治疗长QT综合征的疗效。方法应用口服心得安治疗9例确诊的长QT综合征患者,比较服药前后QTc及心脏事件(晕厥或非致命性心脏骤停)发作情况。心得安治疗过程中出现窦性心动过缓、房室传导阻滞(Ⅰ、Ⅱ、Ⅲ度)者植入DDD起搏器。结果心得安治疗后患者的QTc明显缩短[(512.6±48.6)ms、(544.3±48.4)ms,P<0.05],用药前后心脏事件年发生次数及发生率明显降低[(3.5±3.6)、(0.9±1.1),P<0.01及(0.86±0.92)、(0.34±0.69),P<0.01]。心得安治疗中,9例患者植入DDD起搏器。程控起搏的低限频率为(86±7.8)次/min,9例患者的QTc间期均在正常范围内。术后仅有1例患者复发晕厥。结论β2阻滞剂、起搏器联合治疗可使9例患者中的8例无症状,提示这种联合疗法可为这组高危患者提供长期的合理控制。
Objective To summarize our experience with combined cardiac pacing and beta-blocker therapy in patients with long-QT syndrome. Methods Nine patients with long-QT syndrome were treated with Propranolol. Its effectiveness was analyzed during matched periods before and after starting beta-blocker therapy. If sinus bradycardia, sinus arrest and atrioventricular occurred during the Propranolol treatment, DDD pacemaker were implanted. Results After initiation of beta-blockers, there was a significant reduction in the rate of cardiac events [ （0.86 ±0.92） to （0.34 ±0.69） events per patient per year, P 〈0.01 ] . Numbers of cardiac events per patient were decreased significantly [ （3.5 ± 3.6） to （0.9 ± 1.1 ） ,P 〈0.01 ] after the treatment. Sinus bradycardia in 5 patient and atrioventricular block in 4 patients occurred during the Propranolol treatment were implanted DDD pacemaker. The mean paced rate was （86.0 ± 7.8） beats/min （range, 70 to 100 beats/ min）. After that , QTc in all patient were normal and cardiac events recurred in only one patient. Conclusion Beta-blockers are associated with a significant reduction in cardiac events in LQTS patients. However, syncope and aborted cardiac arrest continue to occur while patients are on prescribed beta-blockers. Because 8 of 9 patients remain without symptoms with beta-blocker therapy and continuous pacing, combined therapy appears to provide reasonable, long-term control for this high-risk group.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2008年第5期439-440,共2页
Journal of Third Military Medical University
