静脉注射三磷酸腺苷治疗阵发性室上性心动过速病人的护理

阵发性室上性心动过速(PSVT)是一种常见的快速性心律失常,突然发作和终止,心室律规则,频率160/min～220/min,发作时间较长,可引起血流动力学障碍,需紧急处理,目前常用的治疗措施有药物转复、电转复和根治性射频消融手术[1].三磷酸腺苷(ATP)现已成为终止PSVT的一线良药.我院心内科2006年11月-2008年11月用快速静脉注射ATP治疗PSVT 30例,取得了较满意的临床效果.现将护理介绍如下.     

三磷酸腺苷治疗小儿室上性心动过速的护理

目的探讨三磷酸腺苷（ATP）治疗小儿阵发性室上性心动过速（PSVT）的有效护理方法.方法将1995年1月～2004年12月收治95例PSVT患儿随机分A、B 2组,A组50例,PSVT患儿用ATP专业监护组在ATP治疗前、中、后进行周密准备、严密监护,B组45例,行常规监护.结果2组PSVT患儿转复成功率、ATP治疗中发生心律失常情况比较,用X2检验,x^2=6.03,P＜0.05,x^27.67,P＜0.01,具有显著性差异.结论ATP转复小儿PSVT的治疗过程中,护理人员的专业技术水平和整体素质直接影响ATP转复小儿PSVT的成败,因此,设立ATP专业监护护理组,精通本疾病的治疗监护知识和技术,是ATP转复成功的关键.     

三磷酸腺苷治疗小儿室上性心动过速的护理

目的探讨三磷酸腺苷(ATP)治疗小儿阵发性室上性心动过速(PSVT)的有效护理方法.方法将1995年1月～2004年12月收治95例PSVT患儿随机分A、B 2组,A组50例,PSVT患儿用ATP专业监护组在ATP治疗前、中、后进行周密准备、严密监护,B组45例,行常规监护.结果2组PSVT患儿转复成功率、ATP治疗中发生心律失常情况比较,用X2检验,X2=6.03,P＜0.05,X2=7.67,P＜0.01,具有显著性差异.结论ATP转复小儿PSVT的治疗过程中,护理人员的专业技术水平和整体素质直接影响ATP转复小儿PSVT的成败,因此,设立ATP专业监护护理组,精通本疾病的治疗监护知识和技术,是ATP转复成功的关键.     

静脉注射三磷酸腺苷治疗室上性心动过速的护理

三磷酸腺苷现已成为终止阵发性室上性心动过速的一线良药。我院1998～2003年用快速静脉注射三磷酸腺苷治疗阵发性室上性心动过速8例取得了较满意的临床效果。现报告如下。     

三磷酸腺苷治疗阵发性室上性心动过速的体会

1 对象和方法 1.1 病例:本文收集了应用ATP转复的36例、46例次阵发性室上性心动过速的患者,男22例、29例次,女14例、17例次,年龄最小18岁,最大58岁,平均年龄39岁,所有患者均为预激综合征。 1.2 方法:以上所有患者均经过刺激迷走神经无效后,方采用ATP治疗。依用药方法不同分为三组:一组29例次,单独应用ATP20mg,生理盐水稀释至2ml,快速静推(3秒钟内推完);二组12例次,ATP20mg加入液体20～40ml中缓慢静推(3～5分钟     

三磷酸腺苷治疗阵发性室上性心动过速的临床研究

目的:通过对阵发性室上性心动过速患者随机应用不同剂量的三磷酸腺苷(ATP)或心律平进行对照研究,探讨ATP在急诊中的应用价值.方法:2000～2002年急诊的无器质性心脏病的阵发性室上性心动过速50例,随机分成3组给予治疗,其中ATP 0.1 mg/kg组(A1组)18例,ATP 0.2 mg/kg组(A2组)17例,心律平70 mg组15例.ATP采用个体化给药,根据体重计算出相应剂量,不经稀释直接静脉推注,时间小于3 s,后立即给予20 ml生理盐水快速同通道注射.心律平组采用70 mg加入20 ml生理盐水以10 ml/min静脉注射,复律后立即停止注射.结果:应用上述药物均可有效终止发作,各组有效率之间无统计学差异(P＞0.05),但ATP各组复律时间明显短于心律平组(P＜0.001).两组注射ATP后个别患者有胸闷、心悸等,均在4～7 s内自然缓解,无1例发生严重合并症者.结论:ATP有效率高,复律快,短期内可重复使用等优点,改进给药方法后,用药剂量可减小,副作用减轻,可作为急诊终止室上性心动过速发作的一个有效方法.     

三磷酸腺苷转复阵发性室上性心动过速过程中诱发室性及其他心律失常的观察

目的:探讨三磷酸腺苷(ATP)在转复急诊阵发性室上性心动过速(PSVT)过程中出现其他心律失常,及用药中的注意事项.方法:对2000年1月至2002年5月在我科经静脉推注ATP转复的124例PSVT患者.全程观察和记录患者的12导心电图、血压及临床表现.结果:124例PSVT中出现室性异位节律者占42%,其中约1/2患者出现右束支传导阻滞,表明冲动起源于左室间隔下部.ATP诱导的室性心律失常是暂时的,可自行终止.结论:静脉推注ATP转复急诊PSVT过程中室性心律失常的发生率较高,无需进一步干预.对高年患者已存在窦房结功能受损或房室传导阻滞,或正使用β-受体阻滞剂以及有严重器质性心脏病者,应视为静脉注射ATP的禁忌证.     

Intravenous Adenosine Triphosphate Disodium: Its Efficacy and Electrophysiologic Effects on Patients with Paroxysmal Supraventricular Tachycardias

We studied the electrophysiologic effects of intravenous adenosine triphosphate disodium (ATP-2Na) on 17 patients with paroxysmal supraventricular tachycardias (PSVTs). One patient had sinus node (SN) reentry, two had intraatrial (IA) reentry, 7 patients had AV nodal reentry and seven had atrioventricular reentrant tachycardias (AVRTs) with accessory pathways (APs). ATP-2Na was injected during ventricular pacing in patients with AV nodal reentry and AVRTs with APs. A bolus injection of ATP-2Na terminated all the PSVTs within 50 s except for one case of IA reentry (case 2). The sites of block at termination were the atrium in SN reentry and IA reentry, between A and H (AH) or between H and A (HA) in AV nodal reentry, and AH block in all the PSVTs with APs. The sites of action on the patients with AV nodal reentry were both the antegrade and retrograde pathways, while the modes of block were Mobitz type I and type II, respectively. ATP-2Na during ventricular pacing in patients with AV nodal reentry produced Mobitz type II ventriculoatrial block (VAB) in four of seven cases. ATP-2Na during ventricular pacing in patients with AVRTs with APs produced changes of atrial activation sequences in two patients, induction of PSVT in two patients, and Mobitz type II VA block in three patients. The former two phenomena suggested a retrograde AV nodal block and raised the possibility of a simple test for retrograde atrial fusion during ventricular pacing in patients with WPW syndrome. Chest discomfort of short duration was most commonly noted after ATP-2Na administration.     

Recent Caffeine Ingestion Reduces Adenosine Efficacy in the Treatment of Paroxysmal Supraventricular Tachycardia

Objectives:  Caffeine, an adenosine receptor blocker, should theoretically reduce adenosine efficacy in the treatment of paroxysmal supraventricular tachycardia (SVT). We aimed to determine the effect of recent caffeine ingestion on the likelihood of reversion of SVT with adenosine.
Methods:  This was a multicenter, case–control study of adult patients with SVT treated with adenosine between September 2007 and July 2008. The primary endpoint was reversion to sinus rhythm (SR) after a 6-mg adenosine bolus, as a function of recent (within 2, 4, 6, and 8 hours) caffeine ingestion. Caffeine ingestion data were collected using a self-administered questionnaire.
Results:  Of 68 patients enrolled, 52 (76.5%, 95% confidence interval [CI] = 64.4% to 85.6%) reverted after a 6-mg adenosine bolus. There were no significant differences in age, sex, or daily caffeine ingestion between patients who did and did not revert (p > 0.05). However, as a group, patients who did not revert had recently ingested significantly more caffeine (p < 0.05). If caffeine had been ingested less than 2 or 4 hours before the adenosine bolus, the odds of reversion to SR were significantly reduced (odds ratio [OR] = 0.18, 95% CI = 0.04 to 0.93; and OR = 0.14, 95% CI = 0.04 to 0.49, respectively). If caffeine had been ingested less than 6 or 8 hours before the adenosine, the odds of reversion were not reduced (OR = 0.31, 95% CI = 0.09 to 1.02; and OR = 0.31, 95% CI = 0.09 to 1.08, respectively).
Conclusions:  Ingestion of caffeine less than 4 hours before a 6-mg adenosine bolus significantly reduces its effectiveness in the treatment of SVT. An increased initial adenosine dose may be indicated for these patients.
ACADEMIC EMERGENCY MEDICINE 2010; 17:44–49 © 2009 by the Society for Academic Emergency Medicine     

阵发性室上性心动过速并发阵发性房颤危险因素的临床研究

目的:筛选阵发性室上性心动过速(PSVT)患者中并发房颤的临床危险因素。了解PSVT患者中房颤的患病率及PSVT患者房颤发生的可能机制。方法:回顾研究经电生理检查证实为PSVT的患者共630例,其中依据临床记录同时有房颤发作的患者编为房颤组,其余无临床房颤发作的患者为对照组。制订调查表格并详细记录患者人口学资料、临床疾病相关资料、心脏超声检查结果、24h动态心电图结果、电生理检查中确定的PSVT折返机制、旁道数目等资料。利用SPSS进行t检验、χ2检验及Logistic回归分析PSVT患者并发房颤的危险因素。结果:630例(年龄13~79岁,平均年龄44.2±14.3岁男性326人,女性304例)中电生理检查房室结折返性心动过速256例(均为慢-快型),房室折返性心动过速374例,单因素分析表明男性、左房内径大及术前频发房性早搏(在AVRT亚组心电图表现为显性预激)为PSVT患者并发房颤的临床危险因素,多因素分析证明性别为PSVT患者并发房颤的独立临床危险因素。结论:PSVT并发房颤的患者常有一定的临床特征:男性居多,左房内径相对较大。     

新生儿阵发性室上性心动过速的治疗

目的：探讨新生儿阵发性窒上性心动过速（PSVT）的治疗方法。方法：对15例阵发性室上性心动过速患儿的临床资料进行分析。结果：15例患儿中，除1例无效自动出院外。其余患儿均恢复窦性节律。心衰纠正、血清心肌酶恢复正常、肌钙蛋白转阴，于终止发作后4～10d出院．出院后继续服地高辛酏剂3-6个月。结论：（1）PSVT首先采用地高辛静脉注射治疗，若无效则按序分别加用“ATP、心律平、盐酸胺碘酮”；（2）该治疗方法列序安全可靠，值得临床应用。     

普罗帕酮治疗阵发性室上性心动过速的疗效观察

阵发性室上性心动过速（ＰＳＶＴ）是临床上常见的一种快速型心律失常，对该种心律失常的转律药物的选用，各家报道不一。本文总结４６例普罗帕酮的临床应用资料，着重从护理的角度，谈谈自己的体会。１资料与方法１．１对象：本组４６例为１９９５年５月至１９９７年１１...