胺碘酮与β受体阻滞剂联合治疗急性顽固性室性心动过速

目的研究大剂量胺碘酮联合β受体阻滞剂治疗急重症顽固性室性心动过速(室速)病人的疗效及安全性.方法8例急重症器质性心脏病病人,左心室射血分数0.346±0.091.急性顽固性室速发作时予胺碘酮静脉负荷量后并静脉及口服维持,6例联合口服β受体阻滞剂,2例严重心功能不全病人联合静脉用艾司洛尔,在严密监测血压、心律下应用,从小剂量开始逐渐增量,稳定后换口服β受体阻滞剂治疗,调整至最大可耐受量即不影响血压亦不加重心力衰竭(心衰)的合适剂量.结果胺碘酮日最大静脉用量1500～2200 mg,艾司洛尔静脉负荷量5～40 mg后3～33 μg/(kg·min)维持.急性顽固性室速予大剂量胺碘酮联合β受体阻滞剂治疗,严重心功能不全者联合静脉用艾司洛尔,可迅速控制顽固性室速且无心衰加重和血压下降.未见严重毒副作用.结论大剂量胺碘酮联合β受体阻滞剂治疗可有效控制伴有心功能不全的顽固性室速.

Amiodarone Combined with Beta-Blocker for Management of Acute Refractory Ventricular Tachycardias

Objective: To evaluate the safety and efficacy of higher-dose amiodarone combined with beta-blocker in the treatment of a- cute refractory ventricular tachycardias. Methods: Eight patients with severe heart disease and refractory ventricular tachycardias were treated with intravenous and oral amiodarone.Oral beta-blocker was also used in 6 patients. In 2 patients with severe impaired ventricular function, in- travenous emsolol was also given from a small dose initially to a large dose gredually.The dosage was adujsted under the carefully superrision of blood pressure and heart rhythm.The maximum maintenance dose of oral beta-blocker without influencing blood pressure or heart function was continuous thereafter. Results: The maximum dose of intrarenous amiodarone was 1 500-2 200 mg/day.The dose of esmolol was 5-40 mg bo- lus followed by maintenance infusion of 3-33 /ig/(kg-min), In patients with severe impaired ventricular function, combined intravenous amiodarone and emsolol therapy promptly controlled refractory ventricular tachycardias. High dose amiodarone com- bined with beta-blocker was effective in the management of ventricular tachycardias. No worsening of ventricular function or hy- potension was noted.No severe side effect was found. Conclusion: High dose amiodarone combined with beta-blockade is effective in the management of acute refractory ventric- ular tachycardias