地尔硫在防治围手术麻醉期房性快速心律失常、心肌缺血中的作用

The effect of diltiazem on treatment of atrial tachyarrhy thmias and myocardial iachemia perioperative

目的评价静脉注射地尔硫在围手术麻醉期控制房性快速心律失常和防治心肌缺血的有效性和安全性。方法对50例围手术麻醉期发生快速房性心律失常或者心肌缺血的患者,静注地尔硫0.1～0.3mg/kg,于给药前、给药后5分钟、10分钟、30分钟、60分钟监测HR、NIBP、ECG-ST,记录地尔硫的总用量。结果根据围手术期出现的心律失常或心肌缺血的情况分为快速房性心律失常组(Ⅰ组,n=40)和心肌缺血组(Ⅱ组,n=10)。两组患者给药后5分钟心室率开始减慢,10￣30分达到最大效应,Ⅰ组心室率平均减慢34次/分(P<0.05),Ⅱ组心室率平均减慢22次/分(P<0.05)。ST段在给药后30分钟有6例患者完全恢复正常,4例明显改善。两组患者血压在用药早期有轻度下降趋势,在用药后30￣60分钟接近基础值。两组患者地尔硫平均用量约0.12mg/kg。结论静脉注射地尔硫0.1￣0.3mg/kg能有效、快速地控制房性快速心律失常及防治心肌缺血,且不至引起循环功能障碍。

Objective To assess the efficacy and safety of intravenous diltiazem to control the atrial tachyarrhythmias and prevent the myocardial ischemia in surgical patients under general anesthesia. Methods Fifty patients with the atrial tachyarrhythmias or the myocardial ischemia during anesthesia were injected intravenously diltiazem 0.1~0.3 mg/kg, and HR,NIBP,ECG-Stwere measured at 5min before and after medication. Results The patients were divided into two groups according to the arrhythmias(groupⅠ)or myocardial ischemia(groupⅡ)occurred during anesthesia.The ventricular rate of the patients in both the groups decreased at 5 min after medication,and reached the peak effect within 10~30 min The ventricular rate of group Ⅰdecreased averagely 34 beats per minute and that of griup Ⅱ22.Abnormal ST segment on ECC restored to normal in 6case,obviously improved in 4.The blood pressure of two groups had a mild tenency to decrease at early stage after medication,but which was no statistically different between the two groups.The blood pressure approached the basal value in 30~60 min after medication.The average dose of diltiazem used in the two groups was(7.0±2.8)mg (about 0.12 mg/kg).Conclusion Intravenous injection 0.1~0.3 mg/kg of diltiazem could control atrial tachyarryhthmias effectively and quickly, prevent and treat myocardial ischemia without circulatory dysfunction.