盐酸艾司洛尔心电生理学特性的研究

Electrophysiologic Study of the Effects of Esmolol Hydrochloride

目的：观察国产盐酸艾司洛尔（ｅｓｍｏｌｏｌ对中国人的电生理学效应，以评价其临床应用前景。 方法：对２０例行心内电生理检查的患者分别于静脉注射盐酸艾司洛尔前及注射过程中测定各项心脏电生理指标，包括窦房结、心房、房室结、心室以及希－浦系功能，同时，观察血压、心率与心电图各项参数（ＰＲ、ＱＲＳ、ＱＴ间期）的变化。 结果：用药时与基础状态比较窦房结恢复时间（ＳＮＲＴ）、心房有效不应期（Ａ－ＥＲＰ）、房室结有效不应期（ＡＶＮ－ＥＲＰ）、房室结前传文氏点（ＡＶＮ－ＷＣＬ）、ＡＨ间期明显延长，有显著性差异（Ｐ＜０．０５～０．０１），而窦房结传导时间（ＳＡＣＴ）、ＰＡ间期、ＨＶ间期、心室有效不应期（Ｖ－ＥＲＰ）以及心电图各项参数无明显改变；对收缩压无影响，但可降低舒张压、平均动脉压、心率及心率血压乘积（ＲＰＰ），有显著性差异（Ｐ＜０．０５～０．０１），从而降低心肌耗氧量，而在停药后 ２０ ｍｉｎ内心率，血压，心率血压乘积即基本恢复至基础状态。 结论：国产盐酸艾司洛尔主要作用于窦房结、心房与房室结，对希．浦系和心室功能无影响，起效迅速，停药后临床作用消失快，可根据临床状况的变化及时调整剂量。

Objective: To investigate the electrophysiologic characteristics and clinical application of esmolol hydrochloride. Methods: Twenty patients underwent diagnostic electrophysiologic studies at rest and during esmolol-induced (3-blockade. An initial loading dose of 500fig/(kg- min) was infused for Sminutes and followed by a maintainance infusion of 250 ^g/(kg'min) that continued until completion of electrophysiologic measurements. The measurements initiated 5 minutes after termination of infusion. The adverse effects were observed simultaneously. Results: Esmolol significantly prolonged the sinus node recovery time, atrial and atrioventricular nodal effective refractory periods, the atrioventricular wenckebach cycle length, and AH interval. Esmolol also produced a significant reduction of heart rate, diastolic and mean blood pressure and rate-pressure product. However, esmolol did not influence the sinoatrial conduction time , PA and HV intervals, ventricular effective refractory period, systolic blood pressure, and electrocardiographic parame- ters (p>0.05) Conclusion: Esmolol mainly acts on sinus node and AV node function. Because of its ultrashort duration of action, es- molol is safe and efficient for emergency treatments.