心脏直视术后心室电风暴5例临床分析

摘要

Objective To summary the ventricular electrical storm after open heart surgery occurred early identifica -tion and rescue experience .Methods Retrospective analysis five cases of ventricular electrical storm clinical data after open heart surgery from August 2011 to July 2013 in Xiangyang city central hospital .Combined mitral aortic valve replacement sur-gery in three cases , mitral valve replacement +incomplete endocardial cushion defect correction surgery in one case , one case of coronary artery bypass graft surgery under cardiopulmonary bypass were implemented .Electrical storm occurred postopera-tive cardioversion defibrillation , intravenous metoprolol and amiodarone antiarrhythmic , sedative , potassium , magnesium sup-plementation , comprehensive treatment of coronary artery spasm .Results Four cases successfully converted to sinus rhythm , the latter was discharged after treatment;1 case converted to sinus rhythm after persistent coma 15d, and gave up treatment automatically discharged.5 patients after discharge from hospital outpatient or telephone follow-up from 1 to 12 months, of which three cases had stop ped taking metoprolol , amiodarone , one case of atrial fibrillation persists , continue taking amioda-rone, no special discomfort .One case of coma patients left the hospital and died three days after discharge .3 cases of sinus rhythm ECG patient review , no further episodes of ventricular tachycardia , ventricular fibrillation .Conclusion It demonstra-ted that the underlying cause treated promptly identify and electrical cardioversion defibrillation , metoprolol and amiodarone antiarrhythmic ventricular is key to successful treatment for electrical storm .%目的：总结心脏直视术后心室电风暴发生的早期识别和抢救经验。方法回顾性分析2011年8月-2013年7月襄阳市中心医院心脏直视术后发生心室电风暴5例临床资料。二尖瓣联合主动脉瓣机械瓣膜置换术3例，二尖瓣机械瓣膜置换＋不完全性心内膜垫缺损矫治术1例，冠状动脉旁路移植术1例，手术均在体外循环下施行。术后发生电风暴行电除颤复律，静脉应用美托洛尔及胺碘酮联合抗心律失常、镇静、补钾、补镁、冠状动脉解痉等综合治疗。结果4例成功转复为窦性心律，后期治疗后顺利出院；1例转复为窦性心律后，持续性昏迷15 d，放弃治疗自动出院。5例患者出院后门诊或电话随访1～12个月，其中3例已停服酒石酸美托洛尔片、胺碘酮片，1例仍存在心房纤颤患者，继续服用胺碘酮片，无特殊不适。1例昏迷自动出院患者出院后第3天死亡。3例门诊复查心电图为窦性心律，未再发作室速、室颤。结论注意基础病因治疗、及时识别及电除颤复律、联合美托洛尔及胺碘酮抗心律失常是心室电风暴抢救成功的关键。