大剂量胺碘酮静脉注射治疗顽固性室性心动过速的临床观察

CLINICAL OBSERVATION ON INTRAVENOUS HIGH-DOSE AMIODARONE IN THE TREATMENT OF REFRACTORY VENTRICULAR TACHYCARDIA

①目的观察大剂量胺碘酮静脉注射治疗顽固性室性心动过速的效果及安全性.②方法选择常规抗心律失常药物治疗无效的顽固性室性心动过速病人58例,首次静脉注射胺碘酮3～5 mg/kg,随后静脉泵入维持量1.0～1.5 mg/min,同时口服胺碘酮600～1 200 mg/d,以后依病情逐渐减量至口服胺碘酮200 mg/d.初次负荷量心律失常控制无效者,可每隔30 min追加负荷量150 mg.③结果第1个24 h胺碘酮静脉用量(1 583.4±216.4)mg,口服用量(803±175)mg,总量为(2 505.0±304.2)mg,心律失常有效控制率为86.21%.不良反应:血压下降4例,窦性心动过缓2例,静脉炎2例,未停药对症处理后好转.④结论大剂量胺碘酮静脉注射治疗顽固性室性心律失常有效、安全.

Objective To observe the efficacy and safety of intravenous injection of high-dose amiodarone for refractory ventricular tachycardia(RVT). Methods Fifty-eight RVT patients who had failed to response routine antiarrhythmic treatment were given intravenously 3-5 mg/kg of amiodarone for the initial dose, and maintained with 1.0-1.5 mg/min. Meanwhile amiodarone was given orally, starting from 600-1 200 mg/d, and gradually reduced to 200 mg/d on the basis of patient's status. In patients who failed the initial dose, another 150 mg was added every 30 min. Results The dose of IV, oral and total amiodarone was (1 583.4±216.4)mg, (803±175)mg, and (2 505.0±304.2)mg , respectively, and the effective rate was 86.21%. The adverse effects included decreased blood pressure(4 cases), bradycardia(2), and phlebitis(2).All these patients were managed with symptomatic therapy and improved without the drug withdrawal. Conclusion High dose of intravenous amiodarone is effective and safe for refractory ventricular tachycardia.