心内直视术后快速型心律失常患者的体外同步电复律治疗观察

The Therapy of Synchronized Direct Current Cardioverter in Patients with Tachyarrhythmia after Intracardiac Repair under Direct Vision

目的探讨体外循环下心内直视术后快速型心律失常的体外同步电复律治疗疗效及其安全性.方法对17例心脏体外循环下心内直视术后早期发生快速型心房颤动(简称房颤)或房扑、室上性心动过速、阵发性室性心动过速等心律失常伴血液动力学障碍患者进行体外同步电复律治疗,以咪哒唑仑或地西泮0.1～0.2mg/kg静脉注射镇静,能量选择为直流电双相波0.5～2J/kg,复律次数1～3次,观察治疗前后心电、有创血压、症状、体征的变化.结果所有病例电复律均获成功,心室率及心律得到控制,血液动力学明显改善,血压上升,病人不适主诉消失,意识恢复,未出现严重并发症.结论对于体外循环下心内直视术后快速型心律失常,体外同步电复律是一种速效、安全的治疗方法,特别是心室率过快的房颤会诱发心绞痛和血流动力学的不稳定,电复律不失为及时有效的治疗措施,电复律后的维持治疗也较为重要。

Objective To investigate the curative effect and security of synchronized direct current cardioverter in curing the patients with tachyarrhythmia after intracardiac repair under direct vision.Methods Seventeen patients with atrial fibrillation and rapid ventricular rate,atrial flatter,supraventricular tachycardia,paroxysmal supraventricular tachycardia and with hemodynamics obstacle after cardiopulmonary bypass operations were carried out synchronized direct current cardioverter therapy.0.1～0.2 mg/kg of midazolam or diazepam was intravenously injected to patients,direct current and biphasic wave selected,and the energy was 0.5～2 J/kg,one to three times.The changes of electrical activity,blood pressure,symptoms and signs were observed before and after treatment.Result All patients got successful treatment.Rapid ventricular rate and cardiac rhythm were controlled.Hemodynamics were improved,and blood pressure were increased.Discomfort disappeared,consciousness recovered,and no complications occourred in patients.Conclusions The therapy of synchronized direct current cardioverter is a fast and safe therapy for patients with tachyarrhythmia after intracardiac repair under direct vision.The maintenance treatment is also important.