艾司洛尔治疗快速恶性心律失常临床疗效观察

研究快速恶性心律失常采用艾司洛尔的临床治疗成果。全部患者均进行补液、纠正电解质失衡、营养支持等常规治疗。对照组在此基础上给予胺碘酮进行干预,研究组在常规治疗基础上给予艾司洛尔进行干预。对比两组疗效、治疗前后心律失常发作情况及不良反应。研究组总有效率91.43%,显著好于对照组72.38%(P<0.05)。两组治疗前短阵房速及短阵室速发作频率对比无显著差异(P>0.05),治疗后两组短阵房速及短阵室速发作频率均显著下降(P<0.05),研究组下降幅度显著优于对照组(P<0.05)。研究组不良反应发生率为13.33%,显著低于对照组的30.48%(P<0.05)。快速恶性心律失常尤其是房速和室速采用艾司洛尔治疗效果更为优异,对心律失常发作能够更有效遏制,安全性更好。     

艾司洛尔治疗并发室上性心动过速危重症患者的疗效观察

室上性心动过速是ICU患者常见的一种急重症,因其常严重影响患者血流动力学稳定需紧急处理,若不及时救治,可发生急性左心衰竭,甚至发生心源性休克而危及生命。以往常用腺苷、维拉帕米、普罗帕酮、乙胺碘呋酮、洋地黄等,转复率70％～80％左右。腺苷和乙胺碘呋酮价格较贵,且乙胺碘呋酮可以引起严重的低血压,普罗帕酮具有较强的负性肌力作用,     

胺碘酮治疗快速心律失常的临床疗效分析

回顾性分析我院2013年2月~2016年1月接受胺碘酮治疗的快速性心率失常患者67例,根据不同的给药方式将67例患者分为常规组(32例)和胺碘酮组(35例)。常规组给予止痛、吸氧等常规治疗,口服普罗帕酮150 mg,3次/d。胺碘酮组则在此基础上根据患者情况注射适量胺碘酮,总疗程为8w、比较两组患者的心率、动脉压、血流动力学参数变化等情况。经过治疗,胺碘酮组患者的心率和动脉压改善情况较常规组大,平均动脉压、舒张压、收缩压和心率等均较常规组低(P0.05),总有效率显著高于常规组(P0.05),胺碘酮组的不良反应发生率高于常规组,但无统计学意义(P0.05)。胺碘酮治疗快速性心率失常的有效率较高,能有效改善心率和动脉血压,且安全性较好。     

国产艾司洛尔治疗阵发性室上性心动过速的临床观察

目的:评价国产艾司洛尔治疗阵发性室上性心动过速的疗效和安全性。方法:用国产艾司洛尔治疗阵发性室上性心动过速42例,观察其转复窦性心律和控制心室率的情况,并记录用药前后的血压变化。结果:静脉注射国产艾司洛尔起效时间为4.2±1.5分钟,治疗有效率为78.6％;副作用较少,静脉注射后仅轻度影响收缩压,共有4例出现低血压,给予快速补液后好转。结论:国产艾司洛尔不仅能有效地转复阵发性室上性心动过速,而且使用安全。     

可达龙治疗快速室上性心律失常的疗效观察

近10 a来我们采用Ⅰ类（心律平） 和Ⅲ类（可达龙） 抗心律失常药物分组治疗各种原因引起的快速室上性心律失常发作,其疗效结果报告如下.     

胺碘酮与艾司洛尔治疗快速恶性心律失常的效果对比

探讨胺碘酮与艾司洛尔治疗快速恶性心律失常的临床效果。选择收治的90例快速恶性心律失常患者作为研究对象,按随机数字表法平均分为观察组与对照组各45例,对照组在常规治疗的基础上给予胺碘酮,观察组在常规治疗的基础上加用艾司洛尔,比较两组的临床疗效及不良反应。观察组总有效率为97.78%,与对照组的95.56%无明显区别,差异无统计学意义(P0.05);观察组不良反应发生率为13.33%,明显低于对照组的33.33%,差异具有统计学意义(P0.05)。胺碘酮与艾司洛尔治疗快速恶性心律失常,均可取得显著临床疗效,但艾司洛尔带来的不良反应相对小,因此艾司洛尔可作为治疗快速恶性心律失常的首选药物。     

口服乙胺碘呋酮治疗33例心律失常临床观察

口服乙胺碘呋酮治疗３３例心律失常临床观察广东省揭西县棉湖华侨医院（５１５４３８）吕宣才，李扬馥乙胺碘呋酮（Ａｍｉｏｄａｒｏｎｅ）是一种苯呋喃衍生物，用于临床已有３０多年历史，近几年广泛用于治疗各种心律失常，近期疗效显著，本文对３３例疗效分析报道如下。...     

乙胺碘呋酮治疗心律失常58例临床观察

目的:评价乙胺碘呋酮对伴器质性心脏病的严重心律失常患者的疗效。方法:对118例心律失常患者随机分为两组,按一定的治疗方案,分别服用乙胺碘呋酮和心律平进行治疗。结果:治疗组治疗总有效率达到79.3%,而对照组为43.3%,治疗组疗效明显优于对照组,P<0.005,且副反应发生率低于对照组。结论:乙胺碘呋酮与心律平相比,更能安全有效地控制心律失常,并能改善心功能。     

应用乙胺碘呋酮治疗心律失常153例临床疗效分析

应用乙胺碘呋酮治疗心律失常１５３例临床疗效分析广州市第六人民医院急诊科湛树廉自１９８９年１０月至１９９２年１２月期间，我院急诊科应用乙胶碘呋酮治疗心律失常１５３例。其中男性９３例、女性５５例，最小年龄４０岁、最大年龄为６４岁，均是急诊门诊和急诊留观病...     

Management of atrial tachyarrhythmias in the critically ill: A comparison of intravenous procainamide and amiodarone

Objective To compare the efficacy and safety of intravenous (IV) amiodarone and procainamide for the treatment of atrial tachyarrhythmias (AT) in the critically ill.Design In this prospective study, patients were allocated to drug treatment on the basis of hospital identification number, even for procainamide and odd for amiodarone.Setting Patients were recruited from a teaching hospital ICU and did not include postoperative cardiac patients.Patients and participants 26 patients with AT sustained for at least 1 h and failure to respond to correction of possible precipitating factors were entered in the study. Exclusion criteria were systolic blood pressure (SBP)<80 mmHg, and known hypersensitivity to either drug. Two patients with chronic atrial fibrillation (who received amiodarone) were later excluded from the analysis. In the final analysis, 14 patients received procainamide and 10 amiodarone.Interventions IV amiodarone (3 mg/kg followed by 10 mg/kg/24h, with repeat dose of 3 mg/kg at 1 h if no response) or IV procainamide (10 mg/kg at 1 mg/kg/min followed by infusion of 2–4 mg/min for 24 h, with repeat dose of 5 mg/kg at 1 h if no response).Measurements and results In the procainamide group 10/14 (71%) and in the amiodarone group 7/10 (70%) had converted to sinus rhythm by 12 h. There was no significant difference in response between the groups. SBP was not significantly different from baseline after administration of either drug.Conclusions Procainamide and amiodarone appear to be safe and equally effective in the treatment of AT in the critically ill.     

艾司洛尔预处理对丙泊酚注射痛的影响

目的：观察小剂量艾司洛尔预处理对丙泊酚静脉注射痛的影响。方法：美国麻醉医师协会（ASA）分级为Ⅰ～Ⅱ级且择期行全麻手术的患者120例,随机分为3组,每组40例。经左前臂桡侧浅静脉置入20G套管留置针。麻醉诱导前左上臂包裹气压止血带,加压至70mmHg后,按分组以3mL/10s速度分别静脉注射：0.9%氯化钠液3mL（C组）,利多卡因0.5mg/kg（L组）,艾司洛尔0.25mg/kg（E组）,60s后松开止血带,将2mg/kg丙泊酚在20s内缓慢注入。随后静脉注射芬太尼、维库溴胺,行气管插管全麻。采用4分制记录3组患者丙泊酚注射痛评分,并记录药物预注前（T0）、气管插管前（T1）、气管插管后1min（T2）、气管插管后3min（T3）的平均动脉压（MAP）和心率（HR）。结果：注射痛的发生率C组为65%（26/40）,而L组为10%（4/40）,E组为25%（10/40）,与C组相比显著降低（P〈0.01）。L组和E组中度和重度疼痛的发生率均显著低于C组（P〈0.05和P〈0.01）。E组与L组比较,差异无统计学意义（P〉0.05）。结论：小剂量艾司洛尔预处理合用止血带可有效缓解丙泊酚注射痛。     

艾司洛尔调控腹腔镜胆囊切除术中应激反应的临床研究

目的探讨艾司洛尔应用在全麻下腹腔镜胆囊切除术中凋控术中应激反应，并观察其对术中异丙酚和瑞芬太尼麻醉维持用量及麻醉深度的影响。方法60例择期行全麻下腹腔镜胆囊切除术患者，随机分为三组，Ⅰ组术中麻醉维持用异丙酚、瑞芬太尼和阿曲库铵同时微泵输注，Ⅱ组和Ⅲ组在切皮前1min给予艾司洛尔0．4mg／kg，并分别在术中通过增加艾司洛尔的输注速率来降低异丙酚和瑞芬太尼的麻醉用量，术中根据血压、心率来调节泵注速度以维持其在基础值的±25％之内。采集并记录各组术前基础值、麻醉诱导气管插管、切皮、气腹1、3,5、10min、胆囊分离时共8个时间点的血压、心率及BIS值的变化；记录各组术中异丙酚、瑞芬太尼和艾司洛尔的维持用量；在术前（基础值）、气腹3min、胆囊分离时抽取外周静脉血检测血清皮质醇的浓度。结果所有患者术中麻醉均控制平稳，心率、血压均在预先设定的范围内波动。三组患者同时间点血压、心率、BIS值无显著性差异（P〉0．05）；Ⅱ和Ⅲ组随着术中艾司洛尔用量的增加，异丙酚和瑞芬太尼维持用量分别明显下降，同比有显著性差异（P〈0．05）；三组患者气腹3min、胆囊分离时的血清皮质醇较术前基础值明显降低（P〈0．05）。结论艾司洛尔在全凭静脉麻醉下腹腔镜胆囊切除术中以一定的输注速率微泵给药，能明显降低术中所需的异丙酚及瑞芬太尼的用量，明显抑制围术期的心血管反应和应激激素反应，降低手术麻醉刺激对患者的生理干扰。     

艾司洛尔和乌拉地尔在全麻插管期间对血液对力学及脑电参数、心率变异性的影响

比较全麻病人插管前静脉给予艾司洛尔或用乌拉地尔预防气管插管反应的效果。60例病人随机分为3组，每组20例，Ⅰ组为对照组，插管前2min静注生理盐水10ml。Ⅱ组为艾司洛尔组，插管前2min，1．5mg／kg艾司洛尔加生理盐水10ml静注。Ⅲ组乌拉地尔组，插管前4min，0．4mg／kg乌拉地尔加生理盐水10ml静注。观察插管前、插管后3组SP、DP、HR、BIS、HRV变化。Ⅰ组SP和DP于插管后1min显著升高（P〈0.05），HR在插管后显著升高（P〈0．05），Ⅱ组SP在插管后轻微升高，HR在插管后显著下降（P〈0．05）．Ⅲ组SP于插管后显著下降（P〈0．05），DP于插管后1min显著下降（P〈0．05），艾司洛尔和乌拉地尔均可有效降低应激引起的心血管反应，与乌拉地尔相比，艾司洛尔尚可降低心率，对于心率较快的病人更为有利。     

Dual demand pacing using retriggerable refractory periods for ventricular rate control during paroxysmal supraventricular tachyarrhythmias in patients with dual chamber pacemakers

The use of dual chamber pacing in patients with atrioventricular block and paroxysmal supraventricular tachyarrhythmias may present a clinical dilemma because of the rapid and erratic triggering of ventricular pacing. To avoid this, a variety of pacing methods have now been described, including the use of retriggerable atrial refractory periods or dual demand pacing. This review details the use, advantages, and limitations of this poorly understood algorithm referred to as "pseudo-mode switching."     

Landiolol,an ultra-short-acting β1-blocker,is useful for managing supraventricular tachyarrhythmias in sepsis

AIM: To investigate whether landiolol, an ultra-shortacting β1-antagonist, can safely and effectively control heart rate in septic patients with supraventricular tachyarrhythmias.METHODS: We reviewed all patients with sepsis who admitted to our intensive care unit between January 2006 and December 2011. Sixty one septic patients suffered from supraventricular tachyarrhythmias(heart rate ≥ 120 bpm for 1 h). Among 61 patients, 39 patients were treated with landiolol(landiolol group) and 22 patients were not treated with landiolol(control group). Arterial pressure, heart rate, cardiac rhythm, pulmonary arterial pressure and cardiac output(if a pulmonary arterial catheter was inserted) were compared between the 2 groups at 1, 8 and 24 h after the initiation of tachyarrhythmias. RESULTS: Mean age and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the 2 groups. Paroxysmal atrial fibrillation/flutter(87%), paroxysmal atrial tachycardia(10%), and paroxysmal supraventricular tachycardia(3%) were observed. The initial landiolol dose administered was 6.3 ± 5.8 g/kg per minute. Rapid and substantial reduction of heart rate was observed in the landiolol group without anydeterioration of hemodynamics. Landiolol significantly reduced heart rate(from 145 ± 14 bpm to 90 ± 20 bpm) compared to the control group(from 136 ± 21 bpm to 109 ± 18 bpm, P 0.05). The conversion to sinus rhythm was observed more frequently in the landiolol group than in the control group at every point(P 0.01 at 8 h; P 0.05 at 1 and 24 h).CONCLUSION: Landiolol safely reduced heart rate and, in part, converted to sinus rhythm in septic patients with supraventricular tachyarrhythmias.     

艾司洛尔对冠脉搭桥患者气管插管的影响

目的：研究艾司洛尔对冠心病患者气管插管反应的影响。方法：选择冠脉搭桥患者60例，随机分为3组，Ⅰ组为对照组；Ⅱ组为插管前5rain给艾司洛尔（1．5mg／kg）组；Ⅲ组为插管前即刻给艾司洛尔（1．5mg／kg）组。在诱导前，诱导后，插管后即刻，插管后2min、5min、10min分别监测血压、心率、血氧饱和度、肺动脉压、肺循环阻力、体循环阻力等。结果：3组患者在麻醉诱导后血压、心率都下降（P〈0．01），而肺血流动力学变化不明显。对照组在气管插管后血压和心率明显升高（P〈0．01），而用艾司洛尔的两组血压和心率也升高，但无统计学差异。其中Ⅲ组在插管后5min，10min心率较慢，其中有2例心率为〈40bpm，但血流动力学较稳定，未作处理；而Ⅱ组插管后血压、心率与诱导后无显著差异。插管后，对照组与艾司洛尔两组相比，血压和心率变化较大，有显著差异（P〈0．05）；而肺血流动力学变化不明显。对照组有4例出现室性早搏，而艾司洛尔组无室性心律失常发生。结论：结论艾司洛尔能有效地、安全地抑制冠心痛患者由麻醉气管插管引起的心血管反应，诱导前5min给药更好。     

Treatment of fetal supraventricular tachyarrhythmias

Supraventricular tachyarrhythmia has been encountered in 18 fetuses at the Yale-New Haven Medical Center during the past 4 years. Fourteen of these fetuses had supraventricular tachycardia and underwent in utero antiarrhythmic therapy with maternally administered digoxin either alone, or on combination with verapamil, propranolol, or procainamide. Thirteen of the 14 fetuses had successful in utero conversion of cardiac rhythm to normal sinus rhythm. The 14th patient underwent successful therapy after birth. All 14 fetuses survived despite severe fetal hydrops at the time of diagnosis in 13 of 14. The four remaining fetuses had either atrial flutter (3) or fibrillation. Two of the fetuses with atrial flutter died at birth, the 3rd survived after electrical cardioversion at birth. The fetus with atrial fibrillation converted to normal sinus rhythm and survived after maternal administration of digoxin. Using M-mode and pulsed Doppler echocardiography, the nature and electrophysiologic mechanism of the arrhythmia may be deduced. The latter information is reviewed along with the fetomaternal pharmacology of various antiarrhythmic agents to devise a rational antiarrhythmic treatment program.     

艾司洛尔对妇科腹腔镜手术中丙泊酚用量的影响

目的：探讨艾司洛尔对妇科腹腔镜手术中丙泊酚用量的影响。方法：40例美国麻醉医师学会（ASA）分级Ⅰ-Ⅱ级、择期行妇科腹腔镜手术患者,随机分为艾司洛尔组（E组）和对照组（C组）,每组20例。E组麻醉诱导前15min时,静脉注入艾司洛尔0.5mg/kg,随后以50μg/（kg·min）持续静脉输注直至手术结束;C组以等量的0.9%氯化钠液代替。采用芬太尼（3μg/kg）、丙泊酚（Ce=3μg/mL）及罗库溴铵（0.8mg/kg）诱导插管,术中调整丙泊酚预期血浆浓度Cp值,使得脑双频指数（BIS）波动于40-55。分别记录手术期间丙泊酚用量和苏醒时间,以及麻醉诱导前15min（艾司洛尔给药前,T0）、麻醉诱导前（T1）、插管前（T2）、插管后1min（T3）、气腹后30min（T4）、手术结束时（T5）、拔管后1min（T6）各时点的收缩压（SBP）、心率（HR）和脑双频指数（BIS）值。结果：E组手术期间丙泊酚用量（78.4±11.2μg/（kg·min）少于C组用量（89.3±15.2μg/kg/min）,P〈0.05;E组苏醒时间（10.4±2.5min）短于C组（12.1±2.7min）,P〈0.05。插管后1min（T3）,C组SBP、HR和BIS均高于E组（P〈0.05）。而T4、T5、T6时点,C组HR均高于E组（P〈0.05）。结论：围术期小剂量艾司洛尔持续输注可减少妇科腹腔镜手术中丙泊酚的用量,且使麻醉诱导和苏醒平稳、迅速。     

艾司洛尔对全凭静脉麻醉中瑞芬太尼用量的影响

目的:探讨艾司洛尔对全凭静脉麻醉中瑞芬太尼用量的影响。方法:将40例择期在全凭静脉麻醉下行甲状腺手术的女性患者随机分为2组,每组20例。试验组气管插管后静脉持续输注负荷量艾司洛尔,并维持至拔管后;对照组用等容量0.9%氯化钠溶液代替艾司洛尔。术中根据脑电双频指数调整异丙酚靶控浓度,并根据心率、平均动脉压调整瑞芬太尼靶控浓度。记录患者术中的心率、平均动脉压、脑电双频指数及术后疼痛评分。结果:2组患者各时间点的心率、平均动脉压和脑电双频指数差异均无统计学意义(P0.05);试验组瑞芬太尼用量显著少于对照组(P0.01);试验组在进入麻醉恢复室后5min时的疼痛评分显著高于对照组(P0.05),2组进入麻醉恢复室后30 min及术后24 h疼痛评分的差异均无统计学意义(P0.05)。结论:低剂量艾司洛尔的持续输注可显著减少全凭静脉麻醉中瑞芬太尼的用量。