室性心律失常风暴的治疗

目的观察低能量胸外直流电除颤和静脉应用β-受体阻滞剂治疗室性心律失常风暴的临床疗效及其安全性。方法将室性心律失常风暴患者59例随机分为对照组和艾司洛尔组,其中,对照组31例患者给予静脉应用利多卡因或胺碘酮基础上采用常规电复律治疗;艾司洛尔组28例患者在上述药物治疗基础上静脉给予艾司洛尔并给予低能量电复律治疗。结果艾司洛尔组终止反复室速、室颤成功率显著高于对照组（89.71%vs 39.89%,P〈0.05）,终止室速及室颤所需放电次数[（5.69±1.34）次]和平均放电能量[（95.32±13.21）J]显著少于对照组[（8.63±3.79）次,（P〈0.05）]和[（185.39±25.63）J,（P〈0.05）];两组低血压和缓慢性心律失常的发生率比较差异无统计学意义（45.16%vs 39.29%,3.23%vs 3.57%,38.71%vs 39.29%,P〉0.05）;对照组电复律后总肌酸激酶和乳酸脱氢酶的升高值显著高于艾司洛尔组（P〈0.01）;艾司洛尔组中患者的病死率显著低于对照组（6例,21.43%vs 24例,77.42%,P〈0.01）。结论在常规药物治疗基础上,及时、足量地静脉注射β-受体阻滞剂和低能量电复律治疗室性心律失常风暴是非常有效而且安全的。

Treatment of Ventricular Tachycardia storm

Objective To evaluate the effect of β-blocker associated with low power defibrillation on ventricular tachycardia storm. Methods 59 cases of ventricular tachycardia storm were randomly divided into two groups：control group and Esmolol intervention group. Patients in control group were treated with Lidocaine or Amiodaronehydrochloride and regular electriceardiover- sion;patients in Esmolol intervention group were intravenously administrated with Esmolol Injection associated with low power de- fibrillation on the basis of the treatment of control group. Results The success rate of terminating repeated ventricular tachycar- dia or ventricular fibrillation of Esmolol intervention group was significantly higher than that of control group （89. 71% vs 39.89% ,P 〈0.05 ） ,and its necessary discharge times（5.69 ± 1.34） and average discharge power[ （95.32 _＋ 13.21 ）J] of terminating ventrieular taehyeardia or ventricular fibrillation were considerably decreased than those in control group [ （8.63 ± 3.79）, P 〈 0.05 ] and L （ 185.39 ± 25.63 ） J, P 〈 0.05 ]. No significant difference was found in the incidence of hypotension and bradycardia arrhythmias in patients of both groups（ 45.16% vs 39.29% , P 〉 0. 05 ）. The mortality in control group was markedly increased compared with that in Esmolol group [ 24 （77.42 % ） vs 6 （21.43 % ） , P 〈 0.01 ]. Conclusion On the basis of conventional treatment,intravenous administration of β-blocker injection associated with low power defibrillation was a safe and effective therapy to ventricular tachycardia storm.