重复经皮星状神经节阻滞术治疗非缺血性心肌病室性心动过速电风暴:治疗恶性心律失常的新方法  

Repeated stellate ganglion blockade for the treatment of ventricular tachycardia storm in patients with nonischemic cardiomyopathy:a new therapeutic option for patients with malignant arrhythmias

作　　者：崔畅 周晓凯[2] 竺悦 沈尤美 陈林豆 居维竹[1] 陈红武[1] 顾凯[1] 郦明芳[1] 潘寅兵[2] 陈明龙[1] Cui Chang;Zhou Xiaokai;Zhu Yue;Shen Youmei;Chen Lindou;Ju Weizhu;Chen Hongwu;Gu Kai;Li Mingfang;Pan YinBing;Chen Minglong(Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Anaesthesiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,南京210029 [2]南京医科大学第一附属医院麻醉科,南京210029

出　　处：《中华心血管病杂志》2023年第5期521-525,共5页Chinese Journal of Cardiology

摘　　要：目的本研究旨在阐述使用重复经皮星状神经节阻滞术(R-SGB)治疗非缺血性心肌病室性心动过速(室速)电风暴的经验。方法本研究为前瞻性观察研究。连续纳入南京医科大学第一附属医院2021年6月1日至2022年1月31日药物干预无效的非缺血性心肌病合并室速电风暴患者。患者均在超声引导下接受左侧R-SGB,阻滞药物为5 ml 1%利多卡因,1次/d,连续阻滞7 d。记录患者治疗前后室性心律失常发作情况,随访出院后室性心律失常复发及临床转归情况。统计分析患者阻滞前后室速的负荷变化及长期预后情况。结果共纳入8例患者,年龄为(51.5±13.6)岁,均为男性,5例为扩张性心肌病,剩余2例为致心律失常性右心室心肌病和1例肥厚性心肌病,左心室射血分数为37.8%±6.6%。治疗后6例(75%)患者终止了电风暴,与治疗前[43.0(13.3,276.3)]相比,患者治疗开始后第1天[1.0(0.3,34.0),P<0.05]及治疗完成后第1天[0.5(0.0,19.3),P<0.05]的24 h内室速负荷均明显减少。治疗过程未发生操作相关重大并发症。干预后平均随访(4.8±1.1)个月,患者首次室速复发的中位时间为2个月。结论微创R-SGB是一种安全且有效的终止非缺血性心肌病室速电风暴的新方法,可作为稳定室速电风暴的重要过渡手段。Objectives This study sought to describe our institutional experience of repeated percutaneous stellate ganglion blockade(R-SGB)as a treatment option for drug-refractory electrical storm in patients with nonischemic cardiomyopathy(NICM).Methods This prospective observational study included 8 consecutive NICM patients who had drug-refractory electrical storm and underwent R-SGB between June 1,2021 and January 31,2022.Lidocaine(5 ml,1%)was injected in the vicinity of the left stellate ganglion under the guidance of ultrasound,once per day for 7 days.Data including clinical characteristics,immediate and long-term outcomes,and procedure related complications were collected.Results The mean age was(51.5±13.6)years.All patients were male.5 patients were diagnosed as dilated cardiomyopathy,2 patients as arrhythmogenic right ventricular cardiomyopathy and 1 patient as hypertrophic cardiomyopathy.The left ventricular ejection fraction was 37.8%±6.6%.After the treatment of R-SGB,6(75%)patients were free of electrical storm.24 hours Holter monitoring showed significant reduction in ventricular tachycardia(VT)episodes from 43.0(13.3,276.3)to 1.0(0.3,34.0)on the first day following R-SGB(P<0.05)and 0.5(0.0,19.3)after whole R-SGB process(P<0.05).There were no procedure-related major complications.The mean follow-up was(4.8±1.1)months,and the median time of recurrent VT was 2 months.Conclusion Minimally invasive R-SGB is a safe and effective method to treat electrical storm in patients with NICM.

关 键 词：室性心动过速 电风暴 星状神经节 神经阻滞 交感神经 

分 类 号：R541.7[医药卫生—心血管疾病] R542.2[医药卫生—内科学]