静脉注射地尔硫对人心脏电生理的影响

Effect of intravenous diltiazem on intracardiac electrophysiologic parameters in human bings

目的：探讨静脉应用地尔硫（艹卓）对心脏电生理的影响。方法：38例阵发性室上性心动过速患者消融成功后的自愿者，静脉给予地尔硫（艹卓），首剂0．2mg／kg静脉推注（稀释至10～15ml，5min内推完），继续以1～5μg（kg·min）维持滴注，30min后开始测量相关数值。结果：心率减慢，房室结传导时间及有效不应期延长，心房及心室的有效不应期缩短均有统计学差异，心房内的传导时间（高右房起搏至希氏束A波的时间）及HV的传导时间不受影响，心房内的离散度无明显统计学差异。无一例在试验过程中出现窦性心动过缓、窦性停搏及房室传导阻滞发生。结论：静脉滴注地尔硫（艹卓）对心率、房室结的影响是有限的，对窦房结和房室结功能正常者应用是安全的。

Objective ：To evaluate the effect of intravenous diltiazem on cardiac electrophysiolgic parameters in normal people. Methods ：Thirty-eight volunteers with supraventricular tachycardia after successful radiofrequence catheter ablation were administered. A loading dosage of 10rag diltiaem was given intravenously followed by the dosage of 1-5μg/（kg·min） infusion continuously. After 30 minites of intravenous diltiazem,right ventricular and atrial effective refractory period （ERP） in multiple sites were measured with S1S2 programmed electrical stimulation, including the high right atrium（HRA）, the low right atrium（LRA）,the left atrium（LA）,opening of coronary sinus （OC） and the atrioventricular （AV） node. The other electrophysiologic measurements included heart rate,AH interval,HV interval,QRS duration and atrial conduction time. Meanwhile to assessed dispersion of atrial effective refractory period. Result ：Diltiazem gradually decreased heart rate, shortened effective refractory period of atrium and ventricule , lengthened AH conduction time, prolonged AV node functional and effective refractory periods. QRS duration,intra-atrial conduction time and dispersion of atrial effective refractory period were not significant different. No case of ARB and transient nonsymptomatic sinus arrest happened during the trial. Conclusion： Diltiazem can decrease huart rate and lengthen AH conduction time, prolong AV node effective refractory period with a limited range, it is safe to use diltiazem in patients with normal sinoatrial node and atrioventricular node function.