院内获得性尖端扭转型室速防治_伍伟锋.pptVIP

TdP定义 TdP一词也能用描述少数QT 间期不延长的多形性室速，因为部分患者伴有隐匿性长QT 综合征 但最好用来描述QT 间期显著延长（500ms），伴T- U 波畸形的多形性室速，因为这类室速有着不同的发生机制和治疗方法 问题的提出 药物引起的获得性长QT综合征(LQTS)伴TdP发作心脏骤停恶性事件极罕见 与院外服用同一种药物患者相比，住院患者药物LQTS伴TdP发生可能性明显增高 住院患者还其它心律失常促发因素 老年人：有心脏病基础、肝肾功能受损 电解质紊乱 心动过缓 静脉用药 内容 The ECG characteristics of TdP Premonitory ECG Signs of TdP Drugs That Cause TdP TdP Risk Factors Management of Drug-Induced QT Prolongation Management of Drug-Induced TdP 一、Characteristic Pattern of TdP typical feature 1、twisting of the QRS complexes around the isoelectric line not be evident in all ECG leads 2、short-long-short pattern of R-R cycles R-on-T PVC 3、warm-up phenomenon The rate ofTdP:160-240 beats/minute 4、frequently terminates spontaneously Some cases degenerates into VF VF 与TdP 的区别 R-on-T PVC： short coupling interval The rate of VF:250~500 beats/minute does not terminate without defibrillation 二、Premonitory ECG Signs of TdP QT-interval prolongation： male QTc470ms，female480ms QTc 500 ms T-U deformity macroscopic T-wave alternans Circulation.2010,121:1049 三、Drugs That Cause TdP Antiarrhythmic： Procainamide、Quinidine、Sotalol 、Disopyramide、Ibutilide、 Antibiotic： Erythromycin（红霉素）、Clarithromycin、Sparfloxacin pain control： Methadone（美沙酮） Antipsychotic： Chlorpromazine（氯丙嗪）、Thioridazine(硫利达嗪) Gastrointestinal stimulant： Cisapride(西沙比利) Cancer/leukemia： Arsenic trioxide(三氧化二砷) 四、TdP Risk Factors 1、QTc 500 ms 2、Use of QT-prolonging drugs Concurrent use of more than 1 QT-prolonging drug Rapid infusion by intravenous route 3、Heart disease Congestive heart failure Myocardial infarction 4、Advanced age 5、Female sex 6、Hypokalemia 7、Hypomagnesemia 8、Hypocalcemia 9、Treatment with diuretics 10、Impaired hepatic drug metabolism (hepatic dysfunction or drug-drug interactions) 11、Bradycardia Sinus bradycardia, heart block, incomplete heart block with pauses 12、Premature complexes leading to short-long-short cycles 五、Management of Drug-Induced QT Prolongation 1、Continuous QTc monitoring QTc500 ms or increase60ms accompanied