摘要
目的评价静脉注射和口服索他洛尔的血流动力学、电生理作用和临床疗效。方法２３例患者应用右心导管和心室程序刺激评价静注和口服索他洛尔的急性和近期血流动力学和电生理作用；电生理有效者继续口服治疗以观察临床耐受性。结果静注８例患者心律失常不再诱发，口服１４例患者心律失常不再诱发；持续性室性心动过速（ＶＴｓ）组２例诱发新的缓慢型ＶＴｓ，１例恶化为室颤，１例诱发出尖端扭转型室速，另２例ＶＴｓ频率减慢；静脉注射和口服后心率、心脏指数显著下降，体循环血管阻力、肺毛细血管楔压明显升高，静注后３０分钟和口服谷效应时每搏量增加；１６例电生理有效者继续口服治疗，１２例无心律失常复发，仅１例心功能失代偿。结论索他洛尔治疗致命性室性心律失常有较高的电生理及临床疗效，对器质性心脏病患者有负性血流动力学效应，但临床耐受良好。
Objective To evaluate the systemic hemodynamics and electrophysiology effect of intravenous and oral sotalol and its tolerance of long term oral therapy in patients with life threatening ventricular tachyarrhythmias. Methods Twenty three patients, 17 with sustained ventricular tachycardias (VTs), 6 with ventricular fibrilation (VF) were studied. 16 patients were postmyocardial infarction, 4 were right ventricular displasia and 3 were dilated cardiomyopathy. Results Sotalol prevented the induction of arrhythmias in 34.3% with bolus intravenous injection (1 mg/kg body weight) and 60.8% with oral (160 mg twice daily for 10 to 14 days). Both intravenous and oral sotalol led to bradycardia, decreased in cardiac index, increased in left ventricular filling pressure as well as in systemic vascular resistance. The stroke volume increased significantly after sotalol intravenous, but not changed at peak action after oral sotalol. During a follow up of 3 to 6 months, oral sotalol prevented the recurrent of arrhythmias in 12 of 16 patients who were responsed to electrophysiology testing. Congestive heart failure associated with a marked bradycardia developed in one patient. This patient was managed with a reduction in the dosage and with a regimen of digoxin and furosemide. Conclusion Sotalol provided effective prophylaxis against life threatening Ventricular tachyarrhythmias. It exerted significant negative hemodynamics effects but with quite good clinical tolerance, even in patients with compromised heart function.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1999年第1期30-32,共3页
Chinese Journal of Internal Medicine
