异搏定治疗特殊类型室性心动过速的临床疗效与安全性研究

Efficacy and Safety of Verapamil in Treatment of Special Types of Ventricular Tachycardia

目的 :探讨异搏定治疗特殊类型室性心动过速 (室速 )的临床疗效与安全性。方法 :对 2 2例特发性单形性室速和短联律间距室性早搏 (室早 )诱发的多形性室速患者 ,使用异搏定 5～ 1 0 mg/次 ,稀释后缓慢静脉注射 ,监测注药前后的心电与血压改变。室速终止后口服该药 4 0～ 80 mg,3次 / d,维持治疗。结果 :1例患者死亡 ,余 2 1例均予静脉注射该药而及时终止了室速发作 ,部分静脉注射总量超过 2 0 m g的患者出现短时血压下降和窦房结功能抑制。 1 6例口服维持治疗并随访 8个月至 6年的患者 ,室速未再发作或发作次数明显减少。结论 :异搏定对于这类特殊类型室速的疗效肯定 ,安全性较好 ,副作用少 ,不良反应发生与剂量有关。

Objective:To evaluate the efficacy and safty of verapamil in treatment of special types of ventricular tachycardia(VT).Methods:Twenty two patients with idiopathic monomorphic VT and polymorphic VT with extremely short coupling interval were treated with intravenous verapamil in a dose of 5~10mg.Electrocardiogram and blood pressure were continuously monitored before and after intravenous verapamil administration. Oral verapamil in a dose of 40~80mg three times daily was administered to these patients after terminating VT. Results: One patient failed to prevent a fatal event and died, whereas intravenous verapamil timely terminated VT in the other twenty one patients. Short time lower blood pressure and sinus depression developed in some patients when the total intravenous verapamil dose was over 20mg. During a follow up of 8 months to 6 years, oral verapamil prevented the recurrence of VT or significantly reduced the frequency of recurrence in 16 patients. Conclusion:Verapamil is an effective and safe agent for the treatment of the special types of VT. No obvious side effect has been found. Adverse response development is related to the dosage. But verapamil can' t prevent sudden death induced by polymorphic VT with extremely short coupling interval.