静脉胺碘酮在危及生命的室性心律失常中的应用

Intravenous Amiodarone in the Treatment of Life-Threatening Ventricular Arrhythmias.

介绍静脉应用胺碘酮对危及生命的室性心律失常的临床应用经验。 5 6例合并器质性心脏病的反复发作持续性室性心动过速 (VT) /心室颤动 (VF)患者 ,男 42例、女 14例 ,年龄 49.6± 13.8岁 ,其中冠心病心肌梗死 42例、心肌病13例、先天性心脏病 1例。静脉注射胺碘酮首剂 3～ 5mg/kg,10min注入 ,继之以 1.0～ 1.5mg/min维持静脉点滴 ,以后依病情渐减。静脉应用同时加用口服 6 0 0～ 12 0 0mg/2 4h。第 1次负荷量后 ,若心律失常控制不理想 ,可每隔 15～30min再给 1.5～ 3.0mg/kg的追加负荷量。以VT、VF消失为有效。第 1个 2 4h静脉用量 15 86 .5± 316 .8mg。维持静脉点滴 4.5± 2 .6天。总有效率 85 .7%。对持续性VT终止率 2 6 .9%。静脉用药早期对PR、QTc间期、QRS波时限无影响。静脉用药期间 ,3例出现窦性心动过缓 ,经减量后恢复 ;1例出现一过性Ⅱ度房室阻滞 ;12例出现静脉炎。静脉胺碘酮治疗危及生命的室性心律失常安全有效。 2 4h 10 0 0～ 15 0 0mg为较合适的初始静脉用量。

To introduce the experience of intravenous amiodarone in the treatment of patients with life threatening sustained ventricular tachycardia and/or ventricular fibrillation.Fifty six patients with recurrent sustained ventricular tachycardia and/or fibrillation were enrolled in this study,42 males and 14 females,aged 49.6±13.8 years.Medical history included old myocardial infarction in 42,cardiomyopathy in 13,and congenital heart disease in 1.Intravenous loading dose of 3～5 mg/kg of amiodarone was given within 10 minutes,followed by 1.0～1.5 mg/min infusion.The subsequent dose decreased according to the clinical status.Oral amiodarone of 600 mg to1200mg daily was started simultaneously,if possible.If the ventricular arrhythmia was uncontrolled,additional bolus of 1.5～3 mg/kg could be repeated every other 15～30 min.The mean dose was 1586.5mg at the first day.Infusion was maintained for 4.5±2.6 day.The success rate,defined as disappearance of the arrhythmia,was 85.7%.The rate of amiodarone on the termination episodes of ventricular tachycardial was 26.9%.There were no significant changes in the PR,QRS,QTc intervals during IV amiodarone therapy.Three patients developed sinal bradycardia and one transitory Ⅱ atrio ventricular block which recovered after decrease of dosage of amiodarone.Phlebitis occurred in 12 patients.Intravenous amiodarone can be used safely and effectively in patients with life threatening sustained ventricular tachycardia and/or ventricular fibrillation.We suggest that 1000～1500 mg/24 h would be a reasonable starting dose for intravenous amiodarone.