β受体阻滞剂对急性心肌梗死并发恶性心律失常的救治

目的 评价β受体阻滞剂治疗急性心肌梗死(AMI)并发恶性心律失常(频发多源性室早、室速、室颤)的临床疗效。方法 选择2001年1月～2002年12月住院的AMI合并恶性心律失常6例，均为前壁(广泛前壁)AMI患者，在常规治疗(扩冠、抗凝、抗心律失常、补钾、补镁等)基础上应用β受体阻滞剂阿替洛尔或倍他乐克3．125～12.500mg，每日2或3次(Bid或Tid)，以后根据病情逐渐加量到25—50mg，Bid或Tid。2例经多次电击复律及常规抗心律失常药等治疗未能终止室速、室颤发作，静脉应用艾司洛尔，先稀释后静脉注射5～10mg，继以1-2mg／min静脉滴注，约30min终止室速、室颤发作，静脉维持2d后改口服阿替洛尔12.5～50．0mg，Bid或Tid。结果 6例中抢救成功5例．死亡1例，存活率83．33％。除在应用β受体阻滞剂开始阶段2例表现一过性低血压，1例因心功能不全猝死外，未见心功能恶化及致心律失常作用。结论 AMI并发恶性心律失常患者早期合理应用β受体阻滞剂能够有效控制恶性心律失常的发作，降低死亡率。

Beta-blocker therapy in the management of malignant ventricular arrhythmia in patients with acute myocardial infarction]

OBJECTIVE: To evaluate the clinical effectiveness of beta-blocker therapy on malignant ventricular arrhythmia in patients with acute myocardial infarction (AMI). METHODS: Beta-blockers, atenolol or betaloc, were given at the doses of 3.125 to 12.500 mg twice or 3 times a day (Bid or Tid) for management of malignant ventricular arrhythmia in 6 patients with AMI on the basis of conventional therapy. Increasing dosage of 25 to 50 mg was later initiated according to the patients' condition. In 2 cases that failed to respond to conventional antiarrhythmic, esmolol was administered via intravenous injection (5-10 mg) to control malignant ventricular arrhythmia within approximately 30 min, followed by a 2-day course of intravenous infusion at the rate of 1 to 2 mg/min. RESULTS: Five AMI patients survived while death occurred in 1 case due to heart failure. No deterioration of the cardiac function or proarrhythmic effect was observed in the 5 survival cases, but the occurrence of transient hypotension in 2 cases in the early stage of beta-blocker application and death due to cardioc insufficiency in one. CONCLUSION: Adequate use of beta-blockers is necessary in the early stage of AMI for effective control of malignant ventricular arrhythmia and lowering the mortality.