徐庚许++邓优++汤建武

[摘要] 目的 探讨胺碘酮静脉注射治疗顽固性快速心律失常的临床效果。 方法 将184例顽固性快速心律失常患者按照心律失常检查结果分为交感风暴组（94例）和阵发性室上性心动过速组（90例），再按照随机数字表法将以上两组分为胺碘酮组和对照组，交感风暴组中胺碘酮组给予胺碘酮治疗，对照组给予利多卡因治疗；阵发性室上性心动过速组中胺碘酮组给予胺碘酮治疗，对照组给予心律平治疗，观察治疗效果。 结果 交感风暴组：胺碘酮组治疗效果、心律恢复时间以及治疗后心率、血压水平显著优于对照组，差异有统计学意义（P<0.05）；阵发性室上性心动过速组：胺碘酮组治疗效果、心律恢复时间以及治疗后心率、血压水平显著优于对照组，差异有统计学意义（P<0.05）；交感风暴组与阵发性室上性心动过速组相同治疗方案治疗效果、心律恢复时间以及治疗后心率、血压水平比较，差异无统计学意义（P>0.05）；四组不良反应发生率比较，差异无统计学意义（P>0.05）。 结论 静脉用胺碘酮治疗顽固性快速心律失常临床效果显著，对不同心律失常类型均有确切疗效，可作为优选治疗方案。

[关键词] 顽固性快速心律失常；胺碘酮；利多卡因；心律平

[中图分类号] R541.7 [文献标识码] B [文章编号] 1673-9701（2016）25-0092-04

Clinical Study of Intravenous Amiodarone in the Treatment of Refractory Tachyarrhythmia

XU Gengxu DENG You TANG Jianwu

Department of Vasculocardiology， Xiangya Pingkuang Cooperation Hospital， Pingxiang， Jiangxi 337000， China

[Abstract] Objective To explore the clinical effects of intravenous injection of amiodarone in the treatment of refractory tachyarrhythmia. Methods 184 patients with refractory tachyarrhythmia were assigned to the catecholamine storm group （94 patients） and the paroxysmal supraventricular tachycardia group（90 patients） according to the examination results of arrhythmia. The patients were also assigned to the amiodarone group and the control group according to the random number table. In the catecholamine storm group， the amiodarone group was given amiodarone for the treatment， and the control group was given lidocaine； in the paroxysmal supraventricular tachycardia group， the amiodarone group was given amiodarone for the treatment， and the control group was given propafenone. Curative effects were observed. Results The catecholamine storm group： curative effects， recovery time of cardiac rhythm and the heart rate and blood pressure level after treatment in the amiodarone group were significantly better than those in the control group， and the differences were statistically significant （P<0.05）； the paroxysmal supraventricular tachycardia group： curative effects， recovery time of cardiac rhythm and the heart rate and blood pressure level after treatment in the amiodarone group were significantly better than those in the control group， and the differences were statistically significant （P<0.05）； curative effects， recovery time of cardiac rhythm and the heart rate and blood pressure level after treatment were compared between the catecholamine storm group and the paroxysmal supraventricular tachycardia group receiving the same treatment protocol， and the differences were not statistically significant （P>0.05）； incidence rate of adverse reactions was compared between the 4 groups， and the differences were not statistically significant（P>0.05）. Conclusion Intravenous amiodarone in the treatment of refractory tachyarrhythmia has significant clinical effects， and has exact curative effects on different types of arrhythmia， which can be selected as the prioritizing treatment protocol.

[Key words] Refractory tachyarrhythmia； Amiodarone； Lidocaine； Propafenone

顽固性快速心律失常是心律失常的一种，发病率较高，病因复杂，常突然发作、致死率较高，病情持续进展可累及心脏而致其衰竭，需及时进行有效治疗干预[1]。胺碘酮为Ⅲ类抗心律失常药，具有抑制心房及心肌传导纤维的快钠离子内流、减慢传导速度、减低窦房结自律性等作用，能够有效防治室性或室上性早博、室性或室上性心动过速、预激综合征及其伴发的室上性心动过速等，对各种心律失常均有确切效果[2，3]。本研究对胺碘酮在顽固性快速心律失常治疗中的应用效果进行分析，以期为其治疗方案的优化提供参考，现报道如下。