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目的充血性心力衰竭(CHF)中复杂性室性心律失常、非持续性室性心动过速有较高的发病率,伴此类心律失常者年死亡率可达50%,是临床危重病症之一。我们选用胺碘酮治疗CHF并发室性心律失常,旨在探讨该药的安全性和有效性。方法对36例平均年龄为(60.0±8.5)岁的充血性心力衰竭伴有心律失常患者予静脉注射胺碘酮,继之以口服维持。观察心率(HR),QT间期,室性心动过速(VT)、心室纤颤(VF)的发作情况并调整剂量。住院期间,给予心电监护,心电图,心脏彩超检查。结果32例(88%)心律失常被有效控制,其中20例(56%)24 h内、8例(77%)48 h内,3例(86%)72 h内得到有效控制。1例用药后120 h室速控制;3例(0.9%)在停用静脉点滴胺碘酮2~13 d后复发,经再次静脉给药控制;2例(0.5%)用胺碘酮后取得部分疗效;分别合用美托洛尔后取得满意疗效;1例患者因再次心肌梗死于住院期间死亡。本组病例用药前后血压、心电图QTc间期无变化,未发现应用胺碘酮导致或加重的心功能不全者。无明显不能耐受的毒副反应。结论胺碘酮对充血性心力衰竭伴有心律失常的治疗安全有效,至少在非缺血性心肌病心力衰竭中能降低病死率。
Objective To investigate the complicated incidence of ventricular arrhythmia in patients with congestive heart failure (CHF) and non-sustained ventricular tachycardia (CHF). The annual mortality rate of these patients with arrhythmia is up to 50% one. We use amiodarone in the treatment of CHF complicated by ventricular arrhythmias, to explore the safety and efficacy of the drug. Methods Thirty-six patients (60.0 ± 8.5 years) with congestive heart failure and arrhythmia were given intravenous amiodarone followed by oral maintenance. Observed the heart rate (HR), QT interval, ventricular tachycardia (VT), ventricular fibrillation (VF) seizures and adjust the dose. During hospitalization, given ECG, ECG, cardiac ultrasound examination. Results 32 cases (88%) of arrhythmias were effectively controlled, of which 20 (56%) were effectively controlled within 24 h, 8 (77%) within 48 h and 3 (86%) within 72 h. 1 case was controlled at 120 h post ventricular tachycardia; 3 cases (0.9%) relapsed after intravenous drip of amiodarone for 2 ~ 13 days and controlled by intravenous administration again; 2 cases (0.5%) were obtained after amiodarone Partial curative effect; metoprolol combined with satisfactory results; 1 patient died of myocardial infarction during hospitalization. This group of patients before and after treatment of blood pressure, ECG QTc no change, did not find the use of amiodarone caused or aggravated cardiac dysfunction. No obvious intolerable side effects. Conclusions Amiodarone is safe and effective in the treatment of congestive heart failure with arrhythmia, at least in non-ischemic cardiomyopathy heart failure can reduce mortality.