艾司洛尔治疗急性冠脉综合征心室电风暴的临床疗效  

Curative effect of esmolol on ventricular electrical storm in patients with acute coronary syndrome

作　　者：丁超[1] 郭洁[1] 王冬梅[1] 于敏[1] 赵玉英[1] 张莉[1] 

机构地区：[1]解放军白求恩国际和平医院心血管内科,石家庄050082

出　　处：《中国循证心血管医学杂志》2013年第4期358-359,368,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省科技支撑计划项目课题(11276124D)

摘　　要：目的观察静脉应用艾司洛尔治疗急性冠脉综合征并发心室电风暴的临床疗效。方法纳入2008年6月~2013年2月急性冠脉综合征（ACS）并发心室电风暴患者42例，随机分为对照组（n=22）和干预组（n=20），对照组予胺碘酮和（或）利多卡因及电复律等常规治疗；干预组在常规治疗的基础上予艾司洛尔[负荷量0.5 mg/kg，维持量0.05 mg/（kg.min）]及电复律治疗，观察两组的转复成功率和不良反应。结果干预组室速和室颤转复成功率显著高于对照组（95.0%vs.77.3%，P＜0.05），干预组与对照组分别有1例和5例死于无法控制的心律失常；干预组有2例患者出现血压下降，经减少艾司洛尔剂量或加用小剂量多巴胺后血压恢复正常；同时，两组各有1例患者伴有严重的窦性心动过缓，予安置临时心脏起搏器后心率恢复正常。结论静脉注射艾司洛尔治疗急性冠脉综合征并发心室电风暴是安全有效的策略，其治疗效果优于传统治疗策略。但本研究样本量偏小，今后还需进行大样本、多中心研究以进一步观察。Objective To observe the curative effect of esmolol on ventricular electrical storm in the patients with acute coronary syndrome （ACS）. Methods The patients （n=42） with ACS complicated by ventricular electrical storm [refractory ventricular tachycardia （VT） and ventricular fibrillation （VF）] were chosen from Jun. 2008 to Feb. 2013, and randomly divided into control group （n=22） and intervention group （n=20）. The control group was given amiodarone and/or lidocaine and electroversion, and intervention group was given esmolol （loading dose=0.5 mg/kg and maintenance dose=0.05 mg/kg.min） and electroversion besides of the same drugs as control group. The success rate of electroversion and adverse reactions were observed in two groups. Results The success rate of terminating VT and VF was significantly higher in intervention group than that in control group （95%vs. 77.3%, P〈0.05）. There was one case in intervention group and five cases in control group died of uncontrollable arrhythmia. There were 2 cases with hypotension who were recovered after reducing drug dose or adding low-dose dopamine. There was one case with severe sinus bradycardia in two groups respectively who was recovered after implanting temporary pacemakers. Conclusion The intravenous injection of esmolol is a safe and effective treatment strategy for treating ACS complicated by ventricular electrical storm, and its curative effect is better than traditional treatment strategy.

关 键 词：艾司洛尔 心室电风暴 急性冠脉综合征 

分 类 号：R541.7[医药卫生—心血管疾病]