摘要
目的 了解影响阵发性心动过速(PT)发作的因素,提高PT的诱发率,从而明确诊断和满足射频消融手术的需要。方法 对121例确有或疑有PT的病人基础状态下,常规行食管心房调搏(TEAP),不能诱发者静脉滴注(静滴)异丙肾上腺素(ISOP),待心率升至120±10bpm时重复TEAP,如仍不能诱发,则静脉推注(静推)阿托品2min后重复TEAP。结果 121例病人基础状态下诱发出74例,未诱发47例,静滴ISOP后诱发出22例,其中房室折返性心动过速(AVRT)7例,房室结折返性心动过速(AVNRT)11例,阵发性房速(PAT)和特发性室速各2例。未诱发的25例病人静推阿托品后诱发出5例,AVRT和AVNRT各2例,PAT1例。基础状态下与基础状态+静滴ISOP后行TEAP诱发PT相比,P值=0.0030;基础状态下与基础状态+静滴ISOP+静推阿托品后诱发PT相比,P值=0.0002。ISOP可显著缩短快径、慢径、旁路的不应期,P值<0.05。阿托品主要缩短房室交界区(房室结、快径、慢径)的不应期。结论 静滴ISOP可显著提高PT的诱发率,本方案较之在一定程度上可进一步提高PT的诱发成功率,并具备很多优点。ISOP和阿托品主要通过缩短传导系统的不应期而诱发PT。
Purpose-. This investigation aims at exploring the factors influencing ousels of qaroxysmal tachycardia (PT), improving PT inducibility and making clear diagnosis and meeting the need by radiofrequency current catheter operations. Methods-. Transesophageal atrial pacing (TEAP) was routinely performed in 121 pa-, tients with PT or suspecting patients with PT. TEAP was again done when heart rate was rising to 120+]0bpm after isoprotere'nol (ISOP) infusion in patients which was not induced PT by TEAP at baseline state. If PT was not induced by TEAP after ISOP infusion, repeat TEAP was performed after 2 min of intravenous injection of at-ropine. Results; In 74 cases among 121 patients at baseline state, PT was induced by TEAP, 22 cases were induced PT by TEAP after ISOP infusion in 47 cases not induced by TEAP at baseline state, It 7<aseswith atri-oventricular reentrant tachycardia (AVRT), 11 cases with atrioventricular nodal reentrant tachycardia (AVNRT), 2 cases with paroxysmal atrial tachycardia (PAT) and idiopathio ventricular tachycardia (VT) re-spetively. 5 cases were induced PT after introvenous injection of atropine in 2l>fcases not induced by TEAP after Isop infusion (2 cases with AVRT and AVNRT, respectively I jas? with PAT). There was a significant dif-fevence in PT induability by TEAP at baseline state compared with Isop infusion (P = 0. 0030) , and the combination of Isop infusion and atropine injection (P = 0. 0002). ISOP markedly shortens the effective vefractory period of fast, slow and accessory pathway (P<0. 05). Atropine mainly shortens the effective refractory period of fast and slow pathways of atrioventricular node. Conclusion; ISOP infusion significantly improve inducibility of PT. This protocal may further increase PT induability to some extent and possesses many advantages ISOP and atropine dominantly shorten the refractory period of coduction system to induce PT.
出处
《实用医技杂志》
1998年第6期353-356,共4页
Journal of Practical Medical Techniques
关键词
异丙肾上腺素
阿托品
阵发性
心动过速
电生理学
Isoproterenol Atropine Paroxysmal transesphageal atrial pacing Cardiac electrohysi-ology
