胺碘酮治疗急性心肌梗死后室性心律失常临床观察

Clinical Effect of Amiodarone on Ventricular Arrhythmias in Acute Myocardial Infarct

目的探讨胺碘酮(Amiodarone,AM)静脉注射治疗急性心肌梗死危及生命的室性心律失常的疗效与安全性。方法21例急性心肌梗死(AMI)后反复发作持续室性心动过速(VT)/心室颤动(VF)患者,男17例,女4例,年龄56～79(53.5±11.7)岁,对常规抗心律失常药物无效,静脉注射AM首剂150～300mg,10min内静脉注入,继以1.0～1.5mg/min静注维持,以后根据病情加减,静脉给药同时口服胺碘酮600mg/24h,若第一次负荷量后,心律失常控制不满意,可每隔30min再加注75～150mg,直至VT、VF消失为有效。结果第1个24hAM静脉用量(1482.6±304.5)mg,心律失常控制率62%(13/21),72h全部控制。1例大面积心肌梗死15d后再发VT、VF,加用AM后获得控制,2例死于心源性休克。结论静脉注射(AM)治疗AMI后心律失常,安全有效。

Objective To investigate the curative and safety of intravenous Amiodarone in the treatment of ventricular tachycardia（VT） and/or ventricular fibrillation（VF） in acute myocardial infarction（AMI）. Methods Twenty-one AMI patients with recurrent sustained VT and/or VF were enrolled in this study, 17 males and 4 females, aged 56-79 （53.5 ± 11.7） years. Intravenous loading dose 150 to 300 mg of Amiodarone was given in 10 minutes followed by 1.0 to 1.5 mg/kg infusion. The subsequent dose decreased according to the clinical status. If ventricular arrhythmia was uncontrolled, additional bolus of 75 to 150 mg could be repeated every 30 minutes. Oral amiodarone of 600mg daily was started simultaneously. Results The mean dose was （ 1 482.6 ± 304.5 ） mg at the first day. The effectiveness rate was 62% （ 13/21 ） of patients during first 24 hours of treatment and was 100% of patients during the first 72 hours of treatment,one patient of larger area AMI recovered VT, VF during the 15 day of treatment, after additional larger dose of Amiodarone 300mg arrhythmia disappeared. Two patients died of cardiogenic shock. Conclusion The intravenous Amiodarone can be used safely and effectively in patients with ventricular tachycardia and/ or ventricular fibrillation of AMI.