右旋美托咪啶：治疗先天性心脏病围手术期房性和交界性快速型心律失常的一种新药：一项初步研究  

作　　者：Constantinos Chrysostomou Lee Beerman Dana Shiderly Donald Berry Victor O. Morell Ricardo Munoz 林思芳(译) 李成辉(校) 

机构地区：[1]Department of Cardiology, CardiacHospital of Pittsburgh-University of PittsburghIntensive Care Unit, Children'sMedical Center, Pittsburgh, Pennsylvania [2]不详

出　　处：《麻醉与镇痛》2010年第1期50-59,共10页Anesthesia & Analgesia

摘　　要：背景先天性心脏病围手术期常发生房性和交界性快速性心律失常，能增加死亡率和患病率。正常心脏能很好的耐受这类节律紊乱，但对于先天性心脏病患者，则能引起血流动力学的明显紊乱，尤其是在体外循环（CPB）结束后。对这类心律失常的处理更是一种挑战，因为目前的抗心律失常药可能无效且患者很难耐受。在本研究中我们观察了一种主要用于镇静的药物——右旋美托咪啶，在房性和交界性快速心律失常中可能的作用。尽管目前有动物资料提示右旋美托咪啶能预防某些室性心动过速，但缺乏其对这类心律失常治疗作用的相关研究。方法本文是一个回顾性、非随机、非对照研究。14例心脏重症监护室患者，接受右旋美托眯啶镇静／镇痛，同时用以治疗交界逸搏性心动过速（JET）、房性异位性心动过速（AET），折返性室上性心动过速（Re—SVT）、房颤（AF）或交界性加速性心律失常（JAR）。右旋美托咪啶可用作抗心律失常的首选药物或其他抗心律失常药物无效时的补救用药。主要观察终点：（a）Re—SVT在3分钟内，其他各心律失常在2小时内恢复正常窦性节律（NSR）；或（b）心率（HR）降至能改善血流动力学的水平；JET≤170bpm，AET≥20％，AF≤150bpm，对于JAR，能阻止其进一步恶化为JET。结果患儿年龄和体重分别为2±3个月和4±1．5kg。多数心律失常（79％）发生于手术后阶段。9例患者接受右旋美托咪啶作为基本用药，5例作为补救用药。10例患儿（71％）右旋美托咪啶负荷剂量为1．1±0．5μg／kg。12例患儿持续输注速度为0．9±0．3μg·kg^-1·h^-1。13例患儿行机械通气。4例患儿（28％）出现副作用。3例出现低血压，经输液能纠正。1例可能发生了短暂的完全性房室（AV）阻滞。14例患儿中有9例为改善AV同步性，行短暂的房性（7例）或AV序列（BACKGROUND： Atrial and junctional tachyarrhythmias occur frequently during the perioperative period for congenital cardiac surgery and can be a cause of increased morbidity and mortality. These rhythm disturbances that may be well tolerated in a normal heart can cause significant hemodynamic instability in patients with congenital heart defects, particularly during the postcardiopulmonary bypass period. Management of these arrhythmias presents more of a challenge, since currently available antiarrhythmic drugs can be ineffective and poorly tolerated. In this study, we examined the possible effect of dexmedetomidine, a primarily sedative drug, on atrial and junctional tachyarrhythmias. Though some animal data have shown that it can prevent certain types of ventricular tachycardia, its therapeutic role during these types of arrhythmias has not been studied. METHODS： This was a retrospective, nonrandomized, noncontrolled study. Fourteen patients admitted to the cardiac intensive care unit and who received dexmedetomidine for both, sedation/analgesia and for junctional ectopic tachycardia （JET）, atrial ectopic tachycardia （AET）, reentry type supraventricular tachycardia （Re-SVT）, atrial flutter （AF） or junctional accelerated rhythm （JAR） were included. Dexmedetomidine was used as a primary drug or as a rescue if other antiarrhythmics had been used. Our primary end-points were （a） conversion to normal sinus rhythm （NSR） within 3 min for Re-SVT, and 2 h for all other arrhythmias or （b） heart rate （HR） reduction to improve hemodynamics; JET ≤ 170 bpm, AET ≥20%, AF ≤150 bpm and for JAR prevention of progression to JET. RESULTS： The mean age and weight were 2 ±3 mo and 4 ±1. 5 kg, respectively. Most of the arrhythmias （79%） occurred during the postoperative period. Dexmedetomidine was used as a primary treatment in nine and as a rescue in five patients. Ten patients （71%） received an initial loading dose of 1. 1 ±0. 5 μg/kg. A continuous infusion, 0. 9 ±0. 3 μg

关 键 词：快速型心律失常 右旋美托咪啶 先天性心脏病 围手术期 治疗作用 交界性 房性 抗心律失常药物 

分 类 号：R541.7[医药卫生—心血管疾病] R971.93[医药卫生—内科学]