南方医科大学学报

南方医科大学学报 ›› 2004, Vol. 24 ›› Issue (04): 475-476.

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β受体阻滞剂对急性心肌梗死并发恶性心律失常的救治

马会利1, 方业民2, 马永利3, 冯军4, 王克强1, 葛均波1   

  1. 1. 复旦大学附属中山医院心内科, 上海, 200032;
    2. 中国中医研究院广安门医院心电图室, 北京, 100053;
    3. 承德市卫生防疫站, 河北, 承德, 067000;
    4. 承德市中心医院检验科, 河北, 承德, 067000
  • 出版日期:2004-04-20 发布日期:2004-04-20
  • 基金资助:
    收稿日期:2003-4-21。
    作者简介:马会利(1957-),女,2000年毕业于北京协和医科大学阜外心血管病医院,博士,教授,电话:021-64041990-2152,E-mail:MHLLLZ@sina.com

β-blocker therapy in the management of malignant ventricular arrhythmia in patients with acute myocardial infarction

MA Hui-li1, FANG Ye-min2, MA Yong-li3, FENG Jun4, WANG Ke-qiang1, GE Jun-bo1   

  1. 1. 复旦大学附属中山医院心内科, 上海, 200032;
    2. 中国中医研究院广安门医院心电图室, 北京, 100053;
    3. 承德市卫生防疫站, 河北, 承德, 067000;
    4. 承德市中心医院检验科, 河北, 承德, 067000
  • Online:2004-04-20 Published:2004-04-20

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摘要： 目的 评价β受体阻滞剂治疗急性心肌梗死(AMI)并发恶性心律失常(频发多源性室早、室速、室颤)的临床疗效。方法 选择2001年1月~2002年12月住院的AMI合并恶性心律失常6例,均为前壁(广泛前壁)AMI患者,在常规治疗(扩冠、抗凝、抗心律失常、补钾、补镁等)基础上应用β受体阻滞剂阿替洛尔或倍他乐克3.125~12.500 mg,每日2或3次(Bid或Tid),以后根据病情逐渐加量到25~50 mg,Bid或Tid。2例经多次电击复律及常规抗心律失常药等治疗未能终止室速、室颤发作,静脉应用艾司洛尔,先稀释后静脉注射5~10 mg,继以1~2 mg/min静脉滴注,约30 min终止室速、室颤发作,静脉维持2 d后改口服阿替洛尔12.5~50.0 mg,Bid或Tid。结果 6例中抢救成功5例,死亡1例,存活率83.33%。除在应用β受体阻滞剂开始阶段2例表现一过性低血压,1例因心功能不全猝死外,未见心功能恶化及致心律失常作用。结论 AMI并发恶性心律失常患者早期合理应用β受体阻滞剂能够有效控制恶性心律失常的发作,降低死亡率。

Abstract: Objective To evaluate the clinical effectiveness of β-blocker therapy on malignant ventricular arrhythmia in patients with acute myocardial infarction (AMI). Methods β-blockers, atenolol or betaloc, were given at the doses of 3.125 to 12.500 mg twice or 3 times a day (Bid or Tid) for management of malignant ventricular arrhythmia in 6 patients with AMI on the basis of conventional therapy. Increasing dosage of 25 to 50 mg was later initiated according to the patients’ condition. In 2 cases that failed to respond to conventional antiarrhythmic, esmolol was administered via intravenous injection (5-10 mg) to control malignant ventricular arrhythmia within approximately 30 min, followed by a 2-day course of intravenous infusion at the rate of 1 to 2 mg/min. Results Five AMI patients survived while death occurred in 1 case due to heart failure. No deterioration of the cardiac function or proarrhythmic effect was observed in the 5 survival cases, but the occurrence of transient hypotension in 2 cases in the early stage of β-blocker application and death due to cardioc insufficiency in one. Conclusion Adequate use of β-blockers is necessary in the early stage of AMI for effective control of malignant ventricular arrhythmia and lowering the mortality.

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