胺碘酮治疗急性心肌梗死并发复杂快速室性心律失常疗效观察

Observation on treating acute myocardial infarction patients complicated ventricular tachyarrhythmia with amiodarone

目的评价急性心肌梗死（AMI）伴复杂快速室性心律失常（CVT）患者静脉注射胺碘酮的疗效及安全性。方法106例血流动力学稳定的AMI伴复杂快速室性心律失常患者随机分为治疗组（53例）和对照组（53例）。在常规治疗基础上，治疗组53例均采取静脉注射胺碘酮治疗，当血流动力学不稳定时立即改用电转复，转复成功后用胺碘酮维持窦性心律（窦律）；对照组53例均用利多卡因治疗，若无效中途改为胺碘酮，当血流动力学不稳定时立即用电转复，电转复用利多卡因维持窦律。比较两组患者的临床疗效、心功能及心律失常的变化。结果治疗组患者AMI后心绞痛发生率、硝酸甘油消耗量均较对照组减少，治疗组左室射血分数、左室短轴缩短率、左室快速充盈期和左房收缩期左房室瓣血流速度（E／A）均较对照组高（均P〈0．01），治疗组总有效率明显高于对照组（75．5％与62．3％，P〈0．01），尤以室性心动过速的有效率高于对照组（86．7％与50．0％，P〈0．01）。结论静脉注射胺碘酮治疗急性心肌梗死伴复杂快速室性心律失常，安全有效并能改善心功能。

Objective To evaluate the efficiency and safety of amiodarone in patients with acute myocardial infarction（AMI） complicated ventricular tachyarrhythmia（CVT）.Methods 106 CVT patients of AMI with stable haemodynamies was randomized into trial group（53 cases） and control group（3 cases）. Based on routine therapy, the trial group was intravenously given amiodarone. Electrical cardioversion is necessary if the haemodynamies turns to unstable. Intravenous amiodarone will be used for at least 24 hours to maintain sinus rhythm. The control group was administrated intravenous lidocainein. If the patients made no response to lidocainein, given amiodarone as substitute. Electrical cardioversion is necessary when the haemodynamies turns to unstable and lidocainein was followed for at least 24 hours after successful cardioversion to maintain sinus rhythm. The therapeutic effects, cardiac function and the changes of arrhythmia were compared between the two groups. Results The incidence of angina pectoris,con- sumption of nitrates were decreased in trial group when compared with that in control group, whereas the ejection fraction,left ventricle fast filling interval and the mitral valve peak velocity of blood flow during left atrium contrac- tion（E/A） all were higher than that in control group（ all P 〈 0.01 ）. The total effective rate in trial group was higher than that in control group（ 75.5 % vs 62.3 %, P 〈 0.01 ）, especially the ventricular taehyeardia control rate is significantly higher than control group（86.7 % vs 50.0 %, P 〈 0.01 ）. Conclusion Intravenous injection of amiodarone efficaciously control the complicated ventricular tachy-arrhythmia in patients with acute myocardial infarction as well as to improve the cardiac function.