大剂量静脉用胺碘酮治疗顽固性、持续性室性心律失常的临床疗效及安全性

Efficacy and Safety of Intravenous Amiodarone in the Treatment of Refractory,Continuous Ventricular Tachyarrhymias

目的：评价静脉用胺碘酮（ａｍｉｏｄａｒｏｎｅ）对顽固性、持续性室性心动过速（ＳＶＴ）、心室颤动（ＶＦ）患者的临床疗效。方法：２４例ＳＶＴ和（或）ＶＦ患者，其中男１９例，女５例，平均年龄４９．２±１２．４岁；冠心病陈旧性心肌梗死１４例，心肌病７例，心肌炎２例，先天性心脏病１例。静脉注射胺碘酮首剂３～５ｍｇ／ｋｇ，１０分钟内注入，继之以１．０～１．５ｍｇ／ｍｉｎ维持静脉滴注，第１个２４小时总量平均２１６５．０±３８５．４ｍｇ（包括口服量），以后依病情渐减，维持静脉滴注平均４．２±２．５天。静脉应用同时加用口服胺碘酮６００～１２００ｍｇ／ｄ。第１次负荷量后，若心律失常控制不理想，可每隔１５～３０分钟再给１．５～３．０ｍｇ／ｋｇ的追加负荷量。疗效判断以ＳＶＴ和（或）ＶＦ消失为有效。结果：总有效率８３．３％。２例静脉用胺碘酮期间出现窦性心动过缓、窦性停搏及一过性Ⅱ度房室传导阻滞。经减量后恢复。结论：静脉应用大剂量胺碘酮治疗快速性室性心律失常安全有效。

? Objective:To evaluate the efficacy of intravenous amiodarone in the treatment of patient with refractory,continuous ventricular tachycardia and/or fibrillation resistant to 1—3 antiarrhymic agents. Methods:A total of 24 patients with sustained ventricular tachycardia and/or fibrillation were enrolled in this study,19 males and 5 females,aged 492±124 years.Medical history included myocardial infarction in 14,cardiomyopathy in 7,myocarditis in 2,and congenital heart disease in 1.Intravenous loading dose of 3—5 mg/kg of amiodarone was given within 10 minutes,followed by 10—15 mg/min infusion.The mean dose was 2 165.0±385.4 mg at the first day.The subsequent dose decreased according to the clinical status.Infusion was maintained for 42±25 days.Oral amiodarone of 600 mg to 1 200 mg daily was started simultaneously,if possible.If the ventricular arrhythmia was uncontrolled,additional bolus of 15—30 mg/kg could be repeated every other 15—30 min. Results:The success rate,defined as disappearance of the arrhythmia,was 833%.Two patients developed sinal bradycardia,sinus arrest and transitory Ⅱ° atrioventricular block and recovered after decrease of dosage of amiodarone. Conclusion:A large dose of intravenous amiodarone can be used safely and effectively in patients with refractory ventricular tachyarrhythmias.