摘要
目的观察尼非卡兰在治疗宽QRS波心动过速的疗效及安全性。方法回顾性分析2017年7月至2018年10月在汕头大学医学院第一附属医院心脏重症监护室住院期间出现宽QRS波心动过速且予胺碘酮治疗无效(部分使用利多卡因、艾司洛尔等常规抗心律失常药物)的10例患者,观察尼非卡兰静脉应用疗效及安全性。尼非卡兰用法:负荷剂量0.3~0.4 mg/kg静脉注射,除1例静脉负荷后未予维持量外,余维持剂量0.4~0.5 mg·kg-1·h-1静脉注射。复律后立即停用尼非卡兰。结果复律后证实有8例为室性心动过速(室速),其中1例为特发性左心室室速,余2例为室上性心动过速(室上速)。9例转复成功,复律时间最短5 min,最长105 min,平均(41.5±32.7)min,1例患者用药622 min仍无法复律且用药期间出现变态反应。转复成功率为90%(9/10)。24 h内维持窦性心律的比例为88.89%(8/9)。用药期间1例出现QT间期延长,但均未出现尖端扭转型室性心动过速(TdP),用药前后血肌酐、天冬氨酸氨基转移酶、丙氨酸氨基转移酶未见明显变化,P值分别为0.459、0.232、0.414,差异无统计学意义。结论静脉应用尼非卡兰在宽QRS波心动过速治疗中有较好且安全的疗效,复律后立即停用尼非卡兰可减少TdP发生,但还需大样本量的研究。
Objective To observe the efficacy and safety of nifekalant in the treatment of the patients with wide QRS tachycardia who were refractory to amiodarone.Method The present study included 10 patients suffered from wide QRS tachycardia and were refractory to a amiodarone(some patients have used lidocaine,esmolol and other conventional antiarrhythmic drugs to be ineffective)were treated with intravenous nifekalant during the hospitalization of the First Affiliated Hospital of Shantou University Medical College from July 2017 to October 2018.Nifekalant loading dose:0.3-0.4 mg/kg IV,and the maintenance dose:0.4-0.5 mg·kg-1·h-1 IV(one patient did not use maintenance dose).Nifekalant was stopped immediately after the cardioversion.Result Eight patients were confirmed to have ventricular tachycardia after sinus rhythm recovered.One of them was idiopathic left ventricular tachycardia and the other 2 were supraventricular tachycardia.Nine patients were successfully converted and had no recurrence during the observation period.The shortest the cardioversion time was 5 min,and the longest was 105 min,and the average was(41.5±32.7)min.One patient was still unable to recover refractory to nifekalant after 622 min of nifekalant and had allergic reactionsduring the treatment.Intravenous administration of nifekalant successfully terminated in around 90%(9/10)of the patients and 88.89%(8/9)patients maintained sinus rhythm within 24 hours.During the treatment,there was a prolongation of QT interval in one case,but no torsades de pointes(TdP)occurred.There were no significant changes in electrolyte,serum creatinine,aspartate aminotransferans(AST)and alanine aminotransferase(ALT)before and after treatment.Conclusion Intravenous nifekalant is effective and safe in the treatment of wide QRS tachycardia.After cardioversion immediately stop nifekalant can reduce the occurrence of TdP.However,large sample size study is needed.
作者
王欣
杨丽华
许上博
杨海燕
曾国宁
王晓彬
Wang Xin;Yang Lihua;Xu Shangbo;Yang Haiyan;Zeng Guoning;Wang Xiaobin(Department of Cardiology,The First Affiliated Hospital of Medical College of Shantou University,Shantou 515041,China)
出处
《中华心律失常学杂志》
2020年第6期590-594,共5页
Chinese Journal of Cardiac Arrhythmias
