尖端扭转型室性心动过速电复律方式探讨

STUDY ON EFFECT OF ELECTRICAL CARDIOVERSION FOR TORSADE DE POINTES

目的观察尖端扭转型室性心动过速(TDP)发作伴血流动力学紊乱时非同步电复律效果。方法6例患者,TDP发作时QT间期辨别不清或增宽的QRS波群与T波难以区分,伴明显的血流动力学紊乱。均以非同步电击复律,电能为150-300J。结果 5例成功转律,继以补钾补镁,静滴利多卡因,治疗原发病等后无再发作;1例TDP顽固发作,多次非同步电击并补充钾、镁,静脉应用利多卡因和异丙基肾上腺素等药物均无效,继以床旁临时心脏起搏治疗仍不能控制发作,最终因顽固性室颤死亡。结论TDP发作伴严重血流动力学紊乱时,需尽快抢救。因室速频率很快,QRS波群宽大畸形,T波与QRS波群难以区分,放电难以同步,予非同步电击复律可以奏效。

Objective To observe the effect of non - synchronized cardioversion in Torsade de pointes (TDP) cases with hemodynamic turbulence. Methods non - synchronized cardioversion with 150 -300J was performed in 6 TDP cases with obvious hemodynamic compromise and difficult discerned QT intervals or wide QRS complexes and T waves. Results 5 cases were reversed by cardioversion followed by intravenous supplies of magnesium and potassium, infusion of lidocaine and treatment of essential diseases. 1 case was died of repetitive ventricular fibrillation although an additional non- synchronized cardioversion had performed. Intravenous supplies of magnesium and potassium, infusion lidocaine and isoprenaline did not work so did bed side temporary ventricular pacing . Conclusion Immediately treatment is necessary for an episode of TDP with severe hemodynamic instability. Because of rapid ventricular rates, aberrant QRS complexs (wide and bizarre), no distinct T waves and QRS complexes and difficult synchronized of discharge, it is non ?synchronized cardioversion that is an effective technique.