摘要
目的探讨胺碘酮联合盐酸艾司洛尔治疗心室电风暴的疗效,总结治疗经验。方法回顾性分析绍兴市人民医院近5年来心室电风暴(VES)患者的临床资料,入选患者均符合心室电风暴诊断标准,心室电风暴定义为24 h内自发≥2次的伴血流动力学不稳定的室性心动过速和(或)心室颤动,间隔窦性心律,通常需要电转复和电除颤紧急治疗的临床综合征。所有患者均予以电击转复或除颤,患者均应用胺碘酮抗心律失常,胺碘酮无效者加用盐酸艾司洛尔。结果符合条件的患者共15例,其中冠状动脉粥样硬化性心脏病7例,扩张型心肌病3例,Brugada综合征1例,急性心肌炎1例,乌头碱中毒1例,特发性室性心动过速2例。所有患者均予以电击转复或除颤,平均电击4.5次。15例患者中5例经应用胺碘酮等治疗,心室电风暴得以控制,胺碘酮有效率33.3%。10例应用胺碘酮无效的患者,静脉应用盐酸艾司洛尔尚有7例有效,盐酸艾司洛尔对于胺碘酮无效的患者仍有70%的有效率。3例应用上述所有治疗措施无效,当天死亡。共抢救成功12例(80%),死亡3例。存活的12例患者继续口服胺碘酮及美托洛尔维持治疗,其中3例患者植入植入型自动心律转复除颤器(ICD)。所有患者随访半年,猝死1例,其余11例未再复发心室电风暴。结论胺碘酮联合盐酸艾司洛尔控制心室电风暴疗效显著,盐酸艾司洛尔值得进一步的探讨和应用。
Objectives To analyze the management of ventricular electrical storm （VES） with amiodarone and esmolol and summary the experience.Methods We conducted a retrospective analysis during last 5 years in Shaoxing People＇s Hospital.To review and assess the causes,differential diagnosis and treatment were performed in patients with VES.VES was defined by 2 or more sustained episodes of ventricular tachycardia or ventricular fibrillation within 24 hours.All patients were treated with electrical conversion or defibrillation emergently.When amiodarone was ineffective,esmolol was used.Results A total of 15 cases of ventricular electrical storm （VES） were included.Causes of VES included coronary atherosclerotic heart disease （n =7）,dilated cardiomyopathy （n =3）,Brugada syndrome （n =1）,acute myocarditis （n=1）,aconitine poisoning （n =1）,idiopathic ventricular tachycardia （n =2）.All the patients were treated with electrical conversion or defibrillation emergently with averagely 4.5 times.All the cases received intravenous injection of amiodarone,5 of which were effective （the effective rate was 33.3％）.Ten cases were resistant to amiodarone,of which,7 cases were successful managed by intravenous injection of esmolol （the effective rate was 70％）,3 cases died within 24 hours.Totally 12 cases were treated successfully（the total effective rate of amiodarone and esmolol was 80％）.After the VES subsided,3 cases accepted implantable cardioverterdefibrillator （ICD） implantation.All the 12 cases were treated with amiodarone and betaloc oral maintenance.Among them,1 case died suddenly during the half-year follow-up,and no VES recurrence was monitored among the othcrs.Conclusions Combining use of amiodarone and esmolol is effective in management of patients with VES.The early use of beta-blocking agent,especially esmolol,should be considered and studied.
出处
《岭南心血管病杂志》
2014年第1期71-73,共3页
South China Journal of Cardiovascular Diseases
关键词
心室电风暴
艾司洛尔
胺碘酮
ventricular electrical storm
esmolol
amiodarone
