长时间应用盐酸尼非卡兰治疗持续性室性心动过速的安全性与有效性分析

目的分析长时间应用盐酸尼非卡兰（尼非卡兰）治疗持续性室性心动过速（室速）的安全性及有效性。方法顺序入选院内发作持续性室速的患者,分为不同用药时间组观察静脉应用尼非卡兰的复律效果及安全性。结果从2005年9月至2008年11月连续人选16例持续性室速患者,给予负荷量0．5mg／kg后,维持量（0．8mg·kg^-1·h^-1）分为短时组（1h）和长时组（12h）,各8例。维持时间分别为,长时组可以在用药90min后追加第二次负荷量0．25mg／kg。长时组患者左心室射血分数（LVEF）有好于短时组的趋势（0．52±0．14）和（0．39±0．15）,P=0．054。两组各有3例患者在维持用药60min内转复,而长时组另有4例患者在维持量超过60min后转复;用药终止室速即刻患者的QTc均明显长于停药12h后,但转复时两组间QTc差异无统计学意义（P=0．981）。短时组有1例患者出现尖端扭转性室速（Tdp）,其QTc达到了610ms,其他患者未见任何副作用。结论长时间应用尼非卡兰治疗多种疾病并发的室速具有一定的安全性,而且可以明显提高治疗的有效性。但在实际应用中应密切监测QTc以减少Tdp的发生。

The efficacy and safety of long-term nifekalant hydrochloride for treating patients with sustained ventricular tachycardia

Objective To evaluate the safety and efficacy of long-term nifekalant hydrochloride(NIF) in treatment of sustained ventricular tachycardia(S-VT). Methods Recruited patients with S-VT were separated into two groups, short-term group and long-term group. Results From September 2005 to November 2008,16 patients with S-VT were consecutively recruited, and separated into long-term group and short-term group ac-cording to different maintaining period(at least 1 h and 12 h,respectively) with 0.8 mg·kg~(-1)·h~(-1)of NIF after one bolus dose(0.5 mg/kg) injection. Second bolus dose was given if patients didn't recovered sinus rhythm after 90 minutes in long-term group. Better trend of LVEF was observed in long-term group compared with the short-term[(0.52±0.14)vs.(0.39±0.15) ,P=0.054]. Three patients were recovered to sinus rhythm with-in 60 min by continuous NIF using in each group. Another four patients were recovered after 60 min in the long-term group. A significant prolonged QTc intervals was observed in the time of sinus rhythm recovered rather than 12 h stopping of NIF[(543.1±67.4) ms vs. (490.9±51.8)ms] respectively(P<0.001). No difference in QTc intervals were observed in two groups when sinus rhythm recovered (P=0.981). Just one patient occurred Tdp with a peak QTc of 610 ms. No complaints or side-effects were recorded in other patients. Conclusion Acceptable safety and efficacy were observed in long period using of NIF in the treatment of S-VT. Continuous QTc monitoring is necessary in order to prevent Tdp.