19例尖端扭转型室性心动过速的临床分析

Clinic analysis of 19 cases with torsades de pointes ventricular tachycardia

目的探讨院内获得性尖端扭转型室性心动过速(Tdp)的临床特点。方法回顾性分析2009-2014年首都医科大学良乡教学医院心内科监护病房(CCU)明确诊断为院内获得性Tdp患者(19例)的临床资料,收集年龄、性别、基础疾病、家族史等,治疗过程中应用的药物、生化、心电图变化,发生Tdp后治疗方法及效果。结果 1例因服红霉素过量引起,3例冠心病并心绞痛,3例急性心肌梗死急性期,12例为心功能不全。4例应用抗菌药物,5例应用胺碘酮,12例应用利尿剂。所有病例心电图示QT间期延长,低血钾10例,低血镁7例。所有患者均给予补镁补钾,必要时电复律,9例给予临时起搏器提高心室率,10例仅药物治疗;与治疗前比较,治疗后血钾[(3.4±0.4)mmol/L vs.(4.7±0.3)mmol/L,P<0.001]及血镁明显提高[(0.8±0.1)mmol/L vs.(1.1±0.1)mmol/L,P<0.001],QT间期[(504.1±19.0)ms vs.(450.0±21.0)ms,P<0.001]及按心率校正的QT间期(QTc)明显缩短[(512.9±12.9)ms vs.(477.1±11.5)ms,P<0.001]。临时起搏器组室速发作、电复律次数低于单纯药物组。18例痊愈,1例死亡。结论院内获得性Tdp是住院患者发生猝死的重要原因,但及时发现可以治愈,对于有器质性心脏病患者安装临时起搏器效果较好。

Objective To explore the clinic characteristics of acquired torsades de pointes （Tdp）. Methods The clinical data of 19 cases diagnosed as acquired Tdp from 2009 to 2014 in the CCU were retrospectively analyzed. Results The acquired Tdp was caused by excessive intake of erythromycin in 1 patient, unstable angina in 3 cases, acute myocar- dial infarction in 3 cases, and heart failure in 12 cases. Four patients were treated with antibiotics, 5 were treated with amiodarone, 12 were treated with diuretics. Ten cases had hypokalemia and 7 cases had hypomagnesesmia. All the pa- tients had QT prolongation in ECG. They received magnesium sulfate and potassium chloride treatment, and with electri- cal cardio-conversion if necessary, 9 cases received temporary pacing for raising heart rate, 10 cases only treated with drugs. After above treatment, serum potassium [（3.4±0.4）mmol/L vs. （4.7±0.3）mmol/L, P 〈 0.001] and blood magnesium [（0.8±0.1 ）mmol/L vs. （1.1±0.1）mmol/L, P 〈 0.001]increased significantly, QT[（504.1±19.0）ms vs. （ 450.0±21.0）ms, P 〈 0.001 ], QTc[ （ 512.9± 12.9） ms vs. （477.1 ± 11.5）ms, P 〈 0.001 ] shortened. The patients treated with pacing had fewer times of ventricular tachycardia（VT）, electrical cardio-conversion than the patients with drugs. Eighteen cases cured, but 1 pa- tient died. Conclusion Acquired Tdp is an important cause of sudden death in hospitalized patients, but if it is discov- ered early, it could be cured. The effect of temporary pacing is good, especially for patient with organic heart disease.