异搏停治疗体外循环后难以控制的室性心律紊乱

• 作 者: 张慈忱
• 出 处: 国外医学.麻醉学与复苏分册
• 发表日期: 1985年04期
• 关键词: 室性心律 异搏停 普鲁卡因酰胺 心律紊乱 心室纤颤 慢性高血压 氨酰心安 哌唑嗪 钙离子流 心导管检查

严重的室性心律紊乱,包括室性心动过速和心室纤颤,一般多以静脉注射利多卡因,普鲁卡因酰胺,或直流电电击治疗。在急性心肌缺血时,发生此类心律紊乱,是由于依赖钙离子流动所致的观点,已逐渐被注意。作者报道一例冠状动脉旁路手术的病人,男,63岁,术前心导管检查显示严重的冠状动脉狭窄及阻塞。血管造影,左室射血分数为65％。术前心电图证实为窦性心律,心肌下壁有一陈旧的梗塞。其他实验室检查均在正常范围内。术前的药物治疗包括氨酰心安,硝酸甘油及术前三天加用哌唑嗪,以控制慢性高血压。入手术室后,血压185/70mmHg,

Severe ventricular arrhythmias, including ventricular tachycardia and ventricular fibrillation, are mostly treated with intravenous lidocaine, procainamide, or DC shock. In acute myocardial ischemia, the occurrence of such heart rhythm disorders is due to the reliance on calcium ion mobilization, which has drawn increasing attention. The authors report a case of coronary artery bypass surgery in patients, male, 63 years old, preoperative cardiac catheterization showed severe coronary artery stenosis and obstruction. Angiography, LV ejection fraction was 65%. Preoperative ECG confirmed sinus rhythm, myocardial infarction wall has an old. Other laboratory tests are in the normal range. Preoperative drug treatment including atenolol, nitroglycerin and prazosin plus three days before surgery to control chronic hypertension. Into the operating room, blood pressure 185 / 70mmHg,