继发于危重症室速风暴及其治疗.docVIP

继发于危重症室速风暴及其治疗[摘要] 目的：观察静脉应用β-受体阻滞剂治疗室速风暴的临床疗效及其安全性。方法：2005年1月～2008年1月我院收治的室速风暴患者41例，随机分为对照组和倍他乐克干预组。其中，对照组26例患者仅于静脉应用利多卡因或胺碘酮基础上采用电复律治疗；倍他乐克干预组15例患者在上述治疗基础上静脉给予倍他乐克。结果：倍他乐克干预组终止反复室速、室颤成功率显著高于对照组(93.33% vs 34.61%，P0.05)。结论：对于继发于危重症的反复性室速和室颤应认识到有交感风暴的存在，常规治疗基础上，及时、足量地静脉注射β-受体阻滞剂治疗室速风暴是非常有效而且安全的。 [关键词] β-受体阻滞剂；室性心动过速；心室颤动；交感风暴 [中图分类号] R541.7[文献标识码]A [文章编号]1673-7210（2008）11（a）-010-03 Treatment of ventricular tachycardia storm secondary to critical illness ZHANG Qun-ying, NIU Yun-qian, CHEN Bai-rong (Department of Cardiology, the Fifth Affiliated Hospital of Zhongshan University, Guangzhou519000, China) [Abstract] Objective: To evaluate the effect of β-blocker on ventricular tachycardia storm. Methods: 41 patients of ventricular tachycardia storm were randomly divided into two groups from January 2005 to January 2008: control group and Betaloc intervention group. Patients in control group were treated with Lidocaine or Amiodaronehydrochloride and electric cardioversion; patients in Betaloc intervention group were intravenously administrated with Betaloc Injection on the basis of the treatment of control group. Results: The success rate of terminating repeated ventricular tachycardia or ventricular fibrillation of Betaloc intervention group was significantly higher than that of control group(93.33% vs 34.61%, P0.05). Conclusion: It is important to be aware of the existence of ventricular tachycardia storm secondary to critical illness. On the basis of conventional treatment, intravenous administration of β-blocker injection is a safe and effective therapy to ventricular tachycardia storm. [Key words]β-blocker; Ventricular tachycardia; Ventricular fibrillation; Catecholamine storm 室速风暴是指24 h内自发2次或2次以上的室速或室颤，需要紧急治疗的临床症候群，又称交感风暴[1]。临床上常可见到短时间内反复出现的室性心动过速和室颤，它是一种致命性的心律失常，病情危重，死亡率高，是复苏中的难点。由于它多继发于严重外伤、心肌缺血或复苏等，这些情况下患者处于交感兴奋状态，此时易引发交感风暴，从而出现反复发作的顽固性室性心动过速或室颤。以往临床上常按普通室性心律失常的常规治疗方法联合应用Ⅰ、Ⅲ类抗心律失常药物及电复律来处理此类情况，其效果不佳，甚至无效。笔者对短期内反复出现的室速或室颤在上述常规治疗方法基础上予以静脉注射β-