腺苷对流出道室性早搏的影响及其安全性

Effects of adenosine on patients with premature ventricualr contractions originating from the ventricle outflow tract

目的观察腺苷对流出道室性早搏(简称室早)及其窦房结、房室结(双结)的影响,评估腺苷试验在流出道室早患者中的安全性,预测室早的机制,为消融做准备。方法对符合标准的144例流出道室早患者,在室早频发时行腺苷试验,静脉快速给予腺苷12 mg。在腺苷发挥作用后,观察患者室早及双结对腺苷的反应情况。结果应用腺苷后3～5 min内,流出道室早对腺苷有四种反应:①敏感型:60例,占41.7%;②不敏感型:64例,占44.4%;③延迟敏感型:12例,占8.3%;④延迟不敏感型:8例,占5.6%。双结出现四种反应类型:①窦房结抑制型:16例,占11.1%;②房室结抑制型:56例,约占38.9%;③双结抑制型:63例,占43.8%;④无反应型:9例,占6.25%。交感神经出现2种反应:①交感兴奋型:70例,占48.6%;②交感无反应型:74例,占51.4%。结论流出道室早对腺苷的反应以敏感型和不敏感型居多。腺苷对流出道室早患者双结的作用多种多样,以双结抑制及房室结抑制为主。腺苷可安全有效地用于流出道室早的电生理检查。

Objective To investigate the effects of adenosine on sinus node（SN） and atrioventricular node（AVN） in patients（Pts） with premature ventricualr contractions（PVC） originating from the ventricle outflow tract（VOT）.Methods This study included 144 patients with PVC originating from VOT.Adenosine（12mg） was administered intravenously during onset of PVC.The effects of adenosine including subject feeling and electrophysiologic properties were observed.Results Within 3-5 minutes of administration of adenosine,according to the response of adenosine on PVC,four types of reaction were observed： sensitive（60 Patients,41.7%）,insensitive（64 Patients,44.4%）,delayed sensitive（12 Patients,8.3%）,and delayed insensitive（8 Patients,5.6%）.Four reactions about effects of adenosine on SN and AVN were observed as SN suppression（16 Pts,11.1%）,AVN suppression（AVNS,56 Pts,38.9%）,double node suppression（DNS,63 Pts,43.8%） and no response（9 Pts,6.25%）.According to the response of sympathetic nerve,two reactions were observed： Excitation（70 Pts,48.6%）;No response（74 Pts,51.4%）.Conclusion The two common types of reaction of adenosine on PVC are sensitive or insensitive to adenosine.The effects of adenosine on SN and AVN are varible in Pts with PVC from VOT,in which DNS and AVNS are common reactions.