异丙肾上腺素在慢室率阵发性心动过速与非阵发性心动过速鉴别诊断中的运用

Role of isoprenaline in differential diagnosis of paroxysmal tachycardia with slow ventricular rate from non-paroxysmal tachycardia

目的 采用常用标准鉴别慢室率阵发性心动过速与非阵发性心动过速十分困难 ,本文旨在探讨异丙肾上腺素在二者鉴别诊断中的运用及其价值。方法 15例慢室率阵发性心动过速和非阵发性心动过速患者在心动过速时静脉滴注异丙肾上腺素 ,观察其心律和心率变化。结果 6例患者心动过速的频率逐渐增快 ,由 (112 .3± 8.7)次 /min增加到 (178.6± 2 2 .8)次 /min ,诊断为慢性持续性交界性心动过速 (3例 )、慢性房性心动过速 (2例 )和窦房结折返性心动过速 (1例 ) ;另 9例异位心律失常消失 ,转为窦性心动过速 ,停止滴注后数分钟 5例再次出现原心律失常 ,诊断为非阵发性室性心动过速 (3例 )和非阵发性交界性心动过速 (6例 )。结论 阵发性心动过速和非阵发性心动过速的发生机制不同 ,因此对异丙肾上腺素的反应亦不相同。

Objective It is difficultg to differentiate paroxysmal tachycardia with slow ventricular rate from non-paroxysmal tachycardia by common standards.This article aims to explore the role of isoprenaline in the differential diagnosis of two arrhythmias above.Methods The changes of rhythm and heart rate were recorded and analysed in 15 patients with tachycardia with slow ventricular rate before and during and after isoprenaline administration.Results During isoprenaline administration the heart rate of arrhythmias in 6 cases went faster gradually and added up to ( 178.6± 22.8) beats/min from ( 112.3± 8.7) beats/min,chronic sustained junctional tachycardia(3 cases) and chronic atrial tachycardia(2 cases) and sinoatrial reentrant tachycardia(1 case) were diagnosed respectively; the arrhythmias in the other cases disappeared and turned to sinus tachycardia,after isoprenaline administration several minutes the arrhythmias in 5 cases recurred again and non-paroxysmal ventricular tachycardia(3 cases) and non-paroxysmal junctional tachycardia(6 cases) were diagnosed respectively.Conclusion Different mechanisms exist in paroxysmal tachycardia and non-paroxysmal tachycardia and their responses to isoprenaline are different.They can be differentiated from each other by isoprenaline administration.