目的 探讨院前应用胺碘酮治疗急性左心衰竭并发室性心律失常的临床疗效和安全性.方法 对65例急性左心衰竭并发室性心律失常患者均采用常规抗心力衰竭治疗.在此基础上,采用胺碘酮,首剂150 mg加入5%葡萄糖注射液20 mL中10 min内静脉推注完,随后以0.5～1 mg·min-1输液泵输注维持;若心律失常控制不满意,15 min后重复静脉推注150 mg.观察65例患者治疗前后心率(HR)、QT间期、血压(SBP、DBP)及室性心律失常和心功能的疗效、不良反应等情况.结果 65例患者中,室性心律失常治疗后的总有效率为86.2%,其中显效27例(41.5%),有效29例(44.6%),无效9例(13.8%).治疗后HR较治疗前明显地减慢,差异有统计学意义[(67士11)次·min-1vs(103士8)次·min-1,P＜0.05].治疗后QT间期、SBP、DBP与治疗前比较差异均无统计学意义(均P＞0.05).心功能治疗后的总有效率为66.2%,其中显效14例(21.5%),有效29例(44.6%),无效22例(33.8%).2例在静脉推注药物时出现低血压,经减慢静脉推注速度后血压上升.结论 院前应用胺碘酮治疗急性左心衰竭并发室性心律失常有较好的疗效,是治疗急性左心衰竭并发室性心律失常的理想药物.%Objective To explore the clinical curative effect and safety of Aminodarone in the pre-hospital treatment of patients with acute left heart failure complicated with ventricular arrhythmia. Methods Sixty-five cases patients with acute left heart failure complicated with ventricular arrhythmia were treated with conventional anti-heart failure therapy. On this basis, use Amiodarone,the first dose of 150 mg in 5％ glucose injection 20 mL in the intravenous injection within 10 min,followed by 0.5～ 1 mg· min-1 infusion pump to maintain infusion,if the heart failure control of arrhythmia were not satisfied, Amiodarone was repeated intravenous injection 150 mg after 15 min. Observe heart rate (HR), QT interval, blood pressure (SBP, DBP) , the effect of ventricular arrhythmia and heart function,adverse reactions before and after treatment.Results In 65 patients,the total effective rate of ventricular arrhythmia was 86.2％ after treatment,which markedly effective in 27 cases (41.5％) ,effective in 29 cases (44.6％) ,ineffective in 9 cases (13.8％). Heart rate after treatment was significantly slower than before,which was statistically significant difference [(67± 11) times · min-1 vs (103 ± 8) times · min-1 , P＜0.05].QT interval,SBP,DBP after treatment were no statistically significant difference than before (all P＞0.05). The total effective rate of heart function after treatment was 66.2％ ,which markedly effective in 14 cases (21.5％),effective in 29 cases (44.6％),ineffective in 22 cases (33.8％). 2 cases appeared hypotension in the intravenous injection of drugs,blood pressure was rised after the slow intravenous injection speed. Conclusion Amiodarone was effectible and an ideal drug for the pre-hospital treatment of patients with acute left heart failure complicated with ventricular arrhythmia.
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