21例尖端扭转型室性心动过速的临床分析

目的探讨尖端扭转型室性心动过速的发病机制、诊断及治疗效果.方法对21例Tdp的临床特点及心电图特点进行分析,根据Jackman分类法,将其分为3种类型.Ⅰ型(间歇依赖性长QT间期综合征)15例,多为药物、电解质紊乱(低钾、镁、钙)及各种原因所致心动过缓基础上引起.Ⅱ型儿茶酚胺依赖型(先天性Q-T间期延长综合征)2例.1例为儿茶酚胺依赖型,另1例为长间歇依赖型.Ⅲ型(短联律间期室早所致Tdp)4例,其中2例为冠心病急性心肌梗死,另2例为无器质性心脏病证据者,用异搏定终止发作和预防发作有特效,其余对镁盐治疗有效;同时针对不同病因病情采取综合治疗.结果除1例及外伤未来得及治疗死于室颤外其余患者均于发病后30 min～24 h以内得到控制.结论Tdp多数为Ⅰ型,均有晕厥发作,部分患者发生心室颤动.Ⅲ型中2例无器质性心脏病者异搏定治疗有特效.其余以镁盐及针对病因病情采用综合治疗,均使Tdp得到有效控制.

Clinic analysis on 21 cases with torsades de pointes ventricular tachycardia

Objective:To explore the pathogenesis,diagnosis and therapy effect of torsades de pointes ventricular tachycardia.Methods:The clinic and electrocardiogram(ECG)characteristics of21cases with Tdp were analyzed,according to Jackman classification,Tdp was divided into3types.Type I(interval-dependent long Q-T interval syndrome),15cases,was mostly based on tachycardia or bradycardia due to medicine,electrolyte disturbance(hy-pokalemia,hypomagnesimia,hypocalcemia)and so on.Type II,2cases,was catecholamine-dependent(congenital Q-T interval elongation syndrome).One is catecholamine-dependent,while the other was long interval-dependent.Type III(Tdp caused by short polygeminy interval ventricular prematures),4cases,out of which2cases acute my-ocardial infarct resulted from coronary atherosclerotic heart disease,while the other2cases had no evidence for or-ganic heart disease,for this type of Tdp,verapamil could be used to terminate and prevent its episode quite effec-tively,while the other types could obtain effective outcome with magnesium salt therapy;meanwhile comprehensive treatment should be adopted with aim to different etiological factors or situations.Results:Except1cases and trau-ma who died of ventricular fibrillation due to delayed treatment,the other cases were controlled within30mins to24hours after onset.Conclusions:Most of Tdp is type I,always with syncope,among part of patients ventricular fibril-lation occur.In type III,verapamil is a wonder drug for2cases with non-organic heart disease.The other cases adopte comprehensive treatment including magnesium salt and different etiological factors or situations therapies,which all can offer Tdp an effective control.