艾司洛尔在体外循环主动脉开放后顽固性室颤中的应用、

Clinical research of the therapeutic effect of esmolol on refractory ventricular fibrillation occurred after release of aor- tic cross-clamp during cardiopulmonary bypass

目的评价艾司洛尔应用于体外循环主动脉开放后顽固性室颤的临床效果。方法主动脉开放后出现顽固性室颤的瓣膜置换术患者40例，数字表法随机分为艾司洛尔组和对照组，每组20例。两组患者按照1mg／kg分别静脉推注艾司洛尔（10mg／m1）或利多卡因（10mg／m1），2min后继续除颤。2次除颤后仍不能复跳者，采取临床其他常用方法处理，直至心脏复跳。记录开放前主动脉阻断时间、肛温、平均动脉压、血乳酸值、血钾值、pH值；给予艾司洛尔或等浓度利多卡因后记录干预后除颤次数、复跳5min后心律、心率，停机后记录体外循环时间及正性肌力药物用量。结果两组相比较，艾司洛尔组除颤成功率高，复跳5min后心率低，体外循环时间短，正性肌力药物用量少，差异均有统计学意义（P〈0．05）。结论体外循环升主动脉开放后复跳困难的患者，给予艾司洛尔可明显减少除颤次数，提高除颤成功率。同时还可以改善复跳后心脏功能，减少正性肌力药物依赖，缩短体外循环时间。

Objective To evaluate the effect of esmolol on refractory ventricular fibrillation just after aortic declamp dur- ing cardiopulmonary bypass. Methods 40 patients undergoing valve replacement occurring refractory ventricular fibrillation af- ter release of aortic cross-clamp was randomly given esmolol （prepared to 10 mg/ml） 1 mg/kg（ group esmolol, n = 20） , or Li- docaine （prepared to 10 mg/ml） 1 mg/kg（ group control, n = 20）, the endocardial electric defibrillation was continued after 2 min. If the fibrillation still can not be reversed after another two times defribrillation, the routine clinical method would be used. The time of aortic cross-clamp, rectal temperature, MAP, and the value of serum Lactic acid, potassium, and PH were recorded. After intervention, the times of defibrillation, heart rate and rhythm 5 min after reversal were recorded. At the end of CPB, the CPB time and the dosage of positive inotropic drugs were also recorded. Results The success rate of defibrillation was higer in group esmolol than control group（P 〈0.05 ）. Heart rate after reversal in group esmolol were slower than that in control group （ P 〈 0.05 ）. The CPB time of control group was longer than group esmolol （ P 〈 0.05 ）, and the dosage of positive inotropic drugs was significantly higher in control group （ P 〈 0.01 ）. Conclusion When occurring refractory ventricular fibril- lation just after aortic declamp during CPB, Using esomolol by way of intravenous infusion can apparently reduce the frequency of defibrillation, and improve the rate of reversal. It can also be favorable to cardiac function, and decrease the dependency of positive inotropic drugs, and shorten the time of CPB.