静脉注射索他洛尔治疗小儿持续性心动过速疗效探讨

Investigation of the treatment with intravenous sotalol for incessant tachyarrhythmias in children

目的探讨静脉注射索他洛尔治疗心功能正常小儿持续性心动过速的有效性及安全性。方法对2011年10月至2012年4月在清华大学第一附属医院心脏中心小儿科住院治疗的心功能正常的持续性心动过速患儿26例,采用持续静脉注射索他洛尔终止心动过速。观察静脉索他洛尔单独或联合应用普罗帕酮药物疗效、心动过速转复为窦性心律时间、能否有效维持窦性心律。监测用药过程中血压、心率、心律变化及用药后心电图PR间期及QTc间期。结果本组26例患儿单独用静脉索他洛尔有效转复为窦性心律18例(69.2%),转复窦性心律时间(5.3±9.3)h(0.05～26.0h);静脉索他洛尔联合普罗帕酮有效转复为窦性心律6例(23.1%),转复窦性心律时间(18.0±22.3)h(2.0～48.0h);总体转复窦性心律24例(92.3%)。静脉索他洛尔单独或联合应用普罗帕酮对不同类型心动过速转复窦性心律有效率差异无统计学意义,但在转复窦性心律所用时间明显不同。房室折返性心动过速患儿组应用静脉索他洛尔转复窦性心律时间显著快于房性心动过速、心房扑动及室性心动过速(P<0.05)。2例患儿(8.0%)转复为窦性心律48h内心电图示QTc明显延长(由用药前的253～398ms延长至486～500ms),分别于停用静脉注射改为口服索他洛尔后48h和144h心电图QTc恢复正常。全部患儿用药期间无药物相关心律失常及其他毒副反应发生。结论 (1)静脉用索他洛尔可安全有效的用于终止心功能正常的小儿心动过速;(2)用药期间未见药物致心律失常及脏器毒副反应;(3)用药过程中需密切监测心电图QTc间期;(4)联合静脉注射普罗帕酮可提高静脉注射索他洛尔终止心动过速的有效率。

Objective To investigate the safety and efficacy of intravenous（iv） sotalol in the treatment of pediatric incessant tachyarrhythmias with normal cardiac function. Methods Twenty-six children admitted to Pediatric Cardiologic Department of Tsinghua University First Hospital between October 2011 and April 2012 were treated by iv sotalol and the efficacy of solitary iv sotalol and iv sotalol plus iv propafenone were investigated; the duration between start of iv sotalol to the point of reversion to sinus rhythm was also studied and it was investigated whether sinus rhythm could be maintained. Blood pressure, heart rate and rhythm were closely monitored during iv sotalol; QTc and PR interval were measured before and after iv sotalol. Results Eighteen patients （69.2%） were successfully reversed to sinus rhythm during solitary iv sotalol; duration between start of iv sotalol to reversion of sinus rhythm was （5.3 ± 9.3）（0.05～26）hours. Six patients （23.1%）were successfully reversed to sinus rhythm during iv sotalol plus iv propafenone; duration between start of iv sotalol to reversion of sinus rhythm was （18.0 ± 22.3）（2.0～48.0）hours. Totally 24 patients（92.3%）were successfully reversed to sinus rhythm. Successful rates of iv sotalol for different types of tachycardia were almost the same, while durations between start of iv sotalol to the point of reversion to sinus rhythm were obviously different. The duration between start of iv sotalol to the point of reversion to sinus rhythm for AVRT was significantly shorter than AT, AF and VT（P〈0.05）.QTc prolongation（from253～398ms to 486～500ms）appeared in 2 patients （8.0%） within 48hours after sinus rhythm were gained; their QTc reversed to normal range respectively 48 hours and 144 hours after withdrawal of iv sotalol and addition of oral sotalol. No drug-associated arrhythmias or other adverse effects were detected during iv sotalol. Conclusion （1）Intravenous sotalol can be safely and effectively used to terminate pediatric tachycardia with normal cardiac function.（2）No pro arrhythmic effects or intoxication of organs are detected during iv sotalol. （3）Close monitoring of QTc is required during iv sotalol.（4）Addition of iv propafenone can help to improve the efficacy of iv sotalol for tachyarrhythmia.