静注胺碘酮治疗高危病人室性心律失常的临床研究

Clinical Study of Intravenous Amiodarone in the Treatment of Ventricular Arrthythmias for High-risk Patients

目的:研究静脉应用胺碘酮在高危病人室性心动过速(VT)和(或)心室颤动(VF)的临床治疗效果。方法:对常规抗心律失常药物治疗无效,采用静脉注射胺碘酮首剂150 mg稀释10 min内注入,随后以1.0-1.5 mg/min维持静脉点滴(输液泵),以后依病情渐减,当心律失常控制不理想时,可每隔30 min再注入150 mg增加负荷量,同时口服胺碘酮,静脉用药持续5天左右,口服600 mg/日1周,400 mg/日1周,200 mg维持。结果:第1个24 h静脉胺碘酮用量为(1462±320)mg,心律失常控制达58％(36/62),72 h后心律失常控制达96.4％(60/62)。结论:静脉注射胺碘酮对VT和(或)VF安全高效,用药强调个体化。推荐剂量:第一天(24 h)内静脉胺碘酮1000-1500 mg,预防心律失常复发需长期口服胺碘酮。

Objective: To study clinical therapeutic effect of intravenous amiodarone in the treatment of ventricular tachycardia (VT) and/or fibrillation (VF) for high-risk patients. Methods: High-risk patient failed to rspend to antiarrhythmic agents intravenous loading dose 150 mg of amiodarone was give in 10 minutes, followed by 1.0-1.5 mg/ min infusion. The subsequent dose decreased according to the clinical status. If the ventricular arrhythmia was uncontrolled, additional bolus of 150 mg could be repeated every other 30 min,infusion was maintained for about 5 days,oral amiodarone of 600 mg daily was started simultaneously for 7 days,400 mg daily for 14 days,200 mg daily for months. Results: The mean dose was (1460±320)mg at 24 h. The effectiveness rate was 58%(36/62 cases) of patients after 72 h of treatment. Conclusion: Intravenous amiodarone has a high efficacy for treatment of VT and VF for high-risk patients to conventional antiarrhythmic drugs, long term oral amiodarone iv effective for the prevention of arrhythmic events. We suggest that 1000-1500 mg/day would be a reasonable starting dose for intravenous amiodarone.