（优质医学）《胺碘酮抗心律失常治疗应用指南》解读.ppt

静脉胺碘酮控制室率与地尔硫卓一样有效，但低血压的发生率前者较少. 多非力特、伊布利特只有转复作用，无控制室率作用。 心律平虽有B阻滞作用，可以减慢房室传导，但不足以控制房颤心室率，并可能由于房率减慢或变得更规整而引起房室传导增加倒置室率增快。 Ⅰ类抗心律失常药物可能会增快室率（房扑1：1传导） 未用?受体阻滞剂组1314例，合用?受体阻滞剂1373例。 入选患者为近期（心梗后3天至3月）心梗患者，VT/VF20次/日，或4次/h的电风暴患者，分为两组， 根据复苏指南常规接受复苏处理（包括抗心律失常药物），经过初步处理后分为两组。组1交感阻滞在原用的抗心律失常药物停用后1小时内开始B阻滞剂及胺碘酮治疗包括The choices for sympathetic blockade therapy were LSGB or b-blockade. Either intravenous esmolol or propranolol was the b-blocking agent used. Intravenous propranolol was given as a 0.15-mg/kg dose over a period of 10 minutes and then as a 3- to 5-mg dose every 6 hours to maintain sinus rhythm unless the heart rate dropped below 45 bpm. Intravenous esmolol was given as a 300- to 500-mg/kg loading dose for 1 minute followed by a maintenance dose of 25 to 50 mg z kg21 z min21. The maintenance infusion was titrated upward if necessary at 5- to 10-minute intervals until a maximum dose of 250 mg z kg21 z min21 was reached. After informed consent was obtained, LSGB was performed by the anterior paratracheal approach. A 21-gauge needle was passed anteriorly between the trachea and the carotid artery to within several millimeters anterior to the lateral process of the spine. Ten to 20 mL of 1% xylocaine (without epinephrine) was injected until Horner’s syndrome or partial Horner’s syndrome developed. A repeat injection with 10 mL of 0.25% marcaine or xylocaine ACLS组常规应用利多卡因、普鲁卡因胺、溴苄胺。 1周的生存率组1为82％，组2为22％ 美国三家医学研究中心回顾性分析 Significant elevations in T4 rT3, minor decreases in T3, and with minor and transient increases in TSH, but without effect on thyroid-binding globulin. Serum rT3 levels increase as a function of dose and duration of therapy. There is a correlation of rT3 levels with therapeutic responses both during loading and maintenance phases as well as after withdrawal of treatment of steady-state drug effects. Serious adverse effects occurred nearly always in association with four- to fivefold increases of rT3 above baseline values, and disappeared when such levels fe