盐酸尼非卡兰治疗室性心动过速初步经验

Initial experience in treating ventricular tachycardia with nifekalant hydrochloride

目的观察盐酸尼非卡兰（尼非卡兰）治疗室性心动过速（室速）的疗效及安全性。方法从2005年至2007年入选住院期间发作室速的患者，观察静脉注射尼非卡兰的复律效果。结果入选的8例患者心功能（NYHA分级）在Ⅲ～Ⅳ级的有4例，左心室射血分数（LVEF）≤0．45的有6例。均于室速发作时应用尼非卡兰静脉注射，负荷量0．3～0．5mg／kg，除1例患者没有应用维持量外其他患者最大维持量均达到0．8mg·kg^-1·h^-1，持续时间最短60min，最长385min。3例患者心律转复，基础心脏病分别为陈旧性心肌炎、特发性室速和急性心肌梗死。5例患者转复无效，基础心脏病分别为陈旧性心肌梗死2例及扩张性心肌病、致心律失常性右心室心肌病、法洛四联症术后各1例。尼非卡兰使所有患者QTc明显延长，转复时QTc为（529±68）ms。其中1例患者出现尖端扭转性室速（Tdp），其QTc达到了610ms，其他患者中QTc最长为590ms。除1例Tdp电转复外，所有患者肝肾功能、心力衰竭体征及血压等在用药前后均无恶化表现。结论尼非卡兰治疗多种疾病并发的室速具有较好的安全性、有效性。在实际应用中应密切监测QTc以减少严重副作用Tdp的发生。

Objective To investigate the efficacy and safety of nifekalant hydrochloride （NIF） in treating sustained ventricular tachycardia（SuVT）. Methods From 2005 to 2007, we recruited consecutive patients developing SuVT in our hospital and treated with NIF intravenously. Results NIF was used as the treatment in 8 patients with SuVT. The underlying heart diseases they suffered included old myocarditis, idiopathic ventricular tachycardia, acute myocardial infarction, old myocardial infarction, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and post-surgery of Tetralogy of Fallot. Four patients had heart failure with NYHA class between Ⅲ - Ⅳ class, and six patients had low left ventricular ejection fraction （LVEF ≤ 0. 45）. The loading dose of NIF was 0. 3 -0. 5 mg/kg, and the highest maintenance dose was 0. 8 mg·kg^-1·h^-1. SuVT were terminated with NIF in three patients, one of them developed torsade de pointes （Tdp） after loading dose. NIF prolonged QTc in all patients. The longest QTc was 610 ms observed in the patient with Tdp. The other 7 patients didn＇ t complain any disconfforts or show any side-effect. Conclusion The efficacy and safety of NIF as the treatment of SuVT causing by multiple heart diseaseas are acceptable.