胺碘酮治疗58例宽QRS波心动过速临床体会

Clinical Experience of Amiodarone in Treatment of 58 Cases of Wide QRS Wave Tachycardia

目的观察胺碘酮对宽QRS波心动过速的复律效果及使用过程中低血压、心动过缓的发生率。方法应用体表心电图进行宽QRS波心动过速的诊断和鉴别诊断。对58例血流动力学稳定的宽QRS波心动过速患者予以胺碘酮静脉注射,并监测血压、心率的变化。结果用胺碘酮后,在全部患者、室上速患者、室速患者以及不能鉴别者中分别有47、8、35和4例成功转复窦性心律,其样本阳性率分别为81.0%、88.9%、81.4%和66.7%,总体阳性率95%可信区间分别为70.9%～91.1%、52%～100%、67%～92%和22%～96%。用药后有5例患者发生低血压,有3例患者发生较严重的心动过缓(<50次/min),其样本阳性率分别为8.6%和5.2%,相应总体阳性率95%可信区间分别为1.4%～15.8%和0%～10.7%。结论胺碘酮对宽QRS波心动过速具有较好的复律作用,且应用安全性较高。

[ Objective ] To observe the cardioversion effect of amiodarone and incidence of hypotension and bradycardia in the pa- tients with wide QRS wave tachycardia. [ Methods] Diagnosis and differential diagnosis of wide QRS wave tachycardia were performed by surface electrocardiogram. Amiodarone was given intravenously in the patients with wide QRS wave tachycardia and stable hemo- dynamics status. Blood pressure and heart rate were monitored. [ Results] After using amiodarone, 47 patients, 8 supraventricular taehycardia patients, 35 ventrieular tachycardia patients and 4 undistinguished patients successfully returned sinus rhythm, the positive rate of samples was 81.0% 88. 9% ,81.4% and 66. 7%, the overall positive rate of 95% confidence interval was 70.9% ～91.1%, 52% ～ 100% ,67% ～92% and 22% ～ 96% respectively. Incidence of hypotension and serve bradycardia （ 〈 50 bpm）was 8.6% and 5. 2% , the overall positive rate of the corresponding 95% confidence interval was 1.4% ～15.8% and 0% ～ 10.7%, respectively. [ Conclusion] Amiodarone was effective and safe in the cardioversion of wide QRS wave taehyeardia.