不同初始剂量胺碘酮治疗无脉性室速和心室纤颤疗效观察

Effect observation of different initial doses of amiodarone for pulseless ventricular tachycardia and ventricular fibrillation

目的观察不同初始负荷剂量胺碘酮治疗无脉性室速和室颤的效果。方法选择183例无脉性室速和室颤患者,经常规心肺复苏、使用肾上腺素以及3次电除颤未能转复者,随机分为两组:胺碘酮组(n=125):300mg或150mg胺碘酮溶于40mL葡萄糖液中快速静注,再予电除颤,按初始剂量,胺碘酮组又分为300mg组(n=64)和150mg组(n=61);对照组(n=58):仅给予常规肾上腺素、CPR及电除颤;记录并比较各组患者的心律转复时间,入院、出院存活人数。结果两种剂量的胺碘酮均能明显缩短心律转复时间[(9.8±1.7)min,(10.5±2.3)min vs (15.6±2.2)min](P<0.05),提高入院存活率(35.9%,32.8% vs 20.7%)(P<0.05),300mg剂量的胺碘酮的效果略优于150mg剂量组,但差异无统计学意义(P>0.05),胺碘酮对于出院存活率无明显改善。结论300mg与150mg剂量的胺碘酮能有效缩短无脉性室速和心室纤颤患者的心律转复时间,但不能提高出院存活率。

[Objective] To observe the curative effect of different initial doses of amiodarone in treating pulseless ventricular tachycardia and ventricular fibrillation.[Methods] 183 patients with pulseless ventrieular taehycardia or ventricular fibrillation, 125 of whom failed to cardioverse after the conventional cardiopulmonary resuscitation （CPR）, application of adrenalin and 3 times of electric defibrillation, were assingned in 2 groups： amiodarone group （n = 125）： 300 mg or 150 mg amiodarone in 40 mL of glucose injection was used by rapid intravenous injection and then electric defibrillation was performed. According to different initial doses, amiodarone group was divided into 300 mg （n =64） and 150 mg （n =61） groups; In control group （n =58）： conventional cardiopulmonary resuscitation （CPR）, application of adrenalin and electric defibrillation were only used. The cardioversion time and the number of survival patients of admission and discharge were recorded and compared. [Results] The cardioversion time was significantly shortened by the two different doses of amiodarone and it was （9.8_＋1.7） minutes in 300 mg amiodarone group, （10.5_＋ 2.3） minutes in 150 mg amiodarone group and （15.6_＋2.2） minutes in control group, respectively （P 〈0.05）. The ad- mission survival rate was increased by the two different doses of amiodarone and it was 35.9% in 300 mg amiodarone group, 32.8% in 150 mg amiodarone group and 20.7% in control group, respectively （P〈0.05）. The admission survival rate in 300 mg amiodarone group was slightly higher than that in 150 mg amiodarone group without stafistieally significant difference （P 〉0.05）. The discharge survival rate didn＇t improve obviously after using the two different doses of amiodarone. [Conclusion] 300 mg or 150 mg amiodarone can effectively shorten the eardioversion time of the patients with pulseless ventricular tachycardia and ventricular fibrillation, but can＇t increase the discharge survival rate.