目的 研究静脉胺碘酮联合硫酸镁急诊救治恶性室性心律失常的有效性和安全性.方法 观察恶性室性心律失常患者62例.如血流动力学稳定,则予静脉注射胺碘酮观察其转复率;如血液动力学不稳定或发作时为心室颤动,则先予电转复,其后再静脉使用胺碘酮预防发作.用药方法:静脉注射胺碘酮首剂3～5mg/kg,用生理盐水稀释至20 ml,10 min内注入,继之以1.0～1.5 mg/min维持,以后依病情渐减量.初次负荷量后控制不满意或室性心动过速、心室颤动复发,可每隔15～30 min再追加1.5～3.0 mg/kg的静脉负荷量1～2次.另用25%硫酸镁注射液10 ml加入生理盐水40 ml后静脉注射,继以平衡液250 ml+25%硫酸镁20 ml静脉滴注维持.静脉用药期间持续心电、血压监测.每日描记十二导联心电图.结果 第1个24 h胺碘酮静脉用量750～2850mg,平均(1482±387.5)mg,心律失常总控制率66.1%(41/62).用药前后心率[用药前(78±30)次/min;用药后(68±22)次/min]比较,差异有统计学意义(P<0.05),而PR、QTc间期及QRS波时限无明显变化(P>0.05).仅1例患者出现一过性低血压.结论 静脉应用胺碘酮联合硫酸镁适用于急诊救治恶性室性心律失常,有效性和安全性好.%Objective To study the effectiveness and safety of intravenous amiodarone combined with mag-nesium sulfate for emergency treatment of malignant ventricular arrhythmia. Methods The 40 cases of sustained ventricular tachycardia with hemodynamic tolerability had intravenous amiodarone. The 22 case for the onset of he-modynamic instability or when ventricular fibrillation episodes, thorough electrical cardioversion, followed by intra-venous amiodarone combined with 25% magnesium sulfate for prevention of attacks. Results Intravenous amioda-rone dosage during the first 24 hours was 750-2850(14 82±387.5)mg, The total arrhythmia control rate was 66.1% (41/62). Heart rate was statistically improved after treatment (P<0.05), while PB, QTc interval and QR S-wave time was not significantly changed (P>0.05). Only one patient suffered from hypotension. Conclusion The emergency treatment of malignant ventricular arrhythmias with intravenous amiodarone combined with magnesiumsulfate shows good efficacy and safety.
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