急性心肌梗死后顽固性持续室速抢救成功8例分析

Analysis of successful rescue of eight intractable SuVT cases after acute myocardial infarction

目的 通过对 8例急性心肌梗死后顽固性持续室速抢救的资料分析 ,旨在认识此种类型的室速 ,总结抢救顽固性持续室速的经验。方法 8例均为急性心肌梗死演变期或恢复期的患者 ,各种抗心律失常药物治疗无效 ,8例均行同步直流电复律 ,7例转复成功 ,1例 2次电击可转复但不能维持 ,经补充电解质 ,改善心肌缺血之后联合抗心律失常治疗转为窦性心律 ,转复后长期口服胺碘酮维持。结果 8例抢救成功。门诊随访 ,2例存活 4年因心力衰竭而死亡 ,其余 6例长期存活。服用胺碘酮无 1例出现甲状腺功能紊乱 ,肺纤维化 ,尖端扭转型室速等副作用。结论 急性心肌梗死后顽固性持续室速同步直流电复律安全有效 ,但要注意基础病因治疗及维持心肌细胞的极化状态 。

Objective To summarize experience of emergency treatment of intractable SuVT through successful rescue of eight cases of intractable SuVT after acute myocardial infarction.Methods Eight patiens were all convalescents of AMI.Each received an ineffective antiarrhythmic drug treatment.All were treated with sync direct current shock finally.Seven cases SuVT were terminated.One case couldn't maintain sinus rhythm after sync direct current shock,but with electrolytic complement,myocardial ischemia amelioration combined with antiarrhythmic drug treatment,SuVT turned to sinus rhythm and maintained stable since.Results Eight patients were all saved successfully.Two cases survived for four years before finally died of heart failure,Six patients survive up to now with no ill effect of thyro-function disorder,pulmonary fibrosis,and TDVT.Conclusion Sync direct current shock is safe and effective but attention should be paid to etiological factor and maintenance of electrolytic complement as well as taking Amiodarone for a long period.