静脉胺碘酮在恶性室性心律失常中的应用

目的静脉应用胺碘酮对危及生命的室性心律失常的临床应用经验。方法42例合井器质性心脏病的反复发作持续性室性心动过速（VT）/心室颤动（VF）患者，静脉注射胺碘酮首剂3～5mg/kg，10min注入，继之以1．0～1．5rag/min维持静脉点滴，以后依病情渐减。静脉应用同时加用口服600-1200mg/24h。第1次负荷量后，若心律失常控制不理想，可每隔15～30min再给1．5～3．0mg/kg的追加负荷量，以VT、VF消失为有效。结果总有效率85．7％。对持续性VT终止率25％。静脉用药早期对PR、QTc间期、QRS波时限无影响。静脉用药期间，2例出现窦性心动过缓，经减量后恢复；1例出现一过性Ⅱ度房室阻滞；8例出现静脉炎。结论静脉胺碘酮治疗危及生命的室性心律失常安全有效。24h 1000～1500mg为较合适的初始静脉用量。

Intravenous amiodarone in the treatment of life-threatening ventricular arrhythmias

Objective：Intravenous amiodarone in the treatment of life-threatening ventricular arrhythmias. Methods：To introduce the experience of intravenous amiodarone in the treatment of patients with lifethreatening sustained ventricular tachycardia and/or ventricular fibrillation 42 patients with recurrent sustained ventricular tachycardia and/or fibrillation were enrolled in this study, Intravenous loading dose of 3-5 mg/kg of amiodarone was given within 10 minuted,followed by 1.0-1.5 mg/min infusion. subsequent dose decreased according to the clinical status. Oral amiodarone of 600 mg to 1 200mg The daily was started simultaneously, if possible. If the ventricular arrhythmia was uncontrolled, additional bolus of 1.5-3 mg/kg could be repeated every other 15-30 rain. Results： The success rate, defined as disappearance of the arrhythmia,was 85.7%.The rate of amiodarone on the termination episodes of ventricular tachycardial was 25%. There were no significant changes in the PR, QRS,QTcintervals during IV amiodarone therapy. Two patients developed sinal bradycardia and one transitory II atrioventricular block and recovered after decrease of dosage of amiodarone. Phlebitis occurred in 8 patients. Conclusion： Intravenous amiodarone can be used safely and effectively in patients with life-threatening sustained ventricular tachycardia and/or ventricular fibrillation. We suggest that 1000～1500mg/24h would be a reasonable starting dose for intravenous amiodarone.