胺碘酮滴注速度过快相关尖端扭转型室性心动过速

Torsades de Pointes ventricular tachycardia associated with rapid intravenous infusion of amiodarone

1例56岁男性心力衰竭伴心房颤动、甲状腺功能亢进患者因慢性心力衰竭急性发作入院，入院时心室率186次/ min，给予胺碘酮（负荷量150 mg 静脉注射，维持量300 mg 静脉滴注）控制心室率。当晚再次静脉泵入胺碘酮300 mg。次日，患者出现意识不清，心电监护示心率92次/ min，＆amp;nbsp；QT 间期平均0.40 s，频发室性早搏，心室率256次/ min，尖端扭转型室性心动过速及心室颤动交替出现。紧急予心脏捶击、电除颤，心律转为室性心动过速。予利多卡因50 mg 静脉注射后心律转为快速心房颤动，心室率降至140次/ min。实验室检查示血钾3.1 mmol/ L，予10%氯化钾10 ml 加入复方平衡液静脉滴注。停用胺碘酮。心电监护未再出现明显异常。

A 56-year-old male patient with heart failure,atrial fibrillation and hyperthyroidism required hospitalization as a result of acute exacerbation of heart failure. The ventricular rate of the patient was 186 beats/ min when he came to the hospital. He received an IV bolus of amiodarone 150 mg and an intravenous infusion of 300 mg for correction of and keeping his ventricular rate. He was given another 300 mg amiodarone later that day. The next day,he became unconscious. Electrocardiographic monitoring showed that his ventricular rate was 92 beats/ min,QT interval was 0. 40 s on average,premature ventricular beats were frequent,ventricular rate became 256 beats/ min,then torsades de Pointes ventricular tachycardia and ventricular fibrillation appeared alternately. Heart rate was turned into ventricular tachycardia after heart thump and electric defibrillation. He was given an IV bolus of lidocaine 50 mg,his heart rate turned into rapid atrial fibrillation and ventricular rate was 140 beats/ min. Biochemical examination of the patient showed that potassium concentration was 3. 1 mmol/ L. An intravenous infusion of 10% potassium chloride 10 ml plus compound balance fluid was given,and amiodarone was stopped. Electrocardiographic monitoring showed no obvious abnormality.