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目的研究盐酸胺碘酮(可达龙)静脉应用对心脏体外循环手术后心律失常发生率及对心律失常性死亡率的影响。方法回顾性分析2008年1月至2012年2月我科以胺碘酮治疗的心脏术后心律失常58例。本组均为成年患者,年龄18～76岁,入院后经明确诊断、充分术前准备后行心脏手术,术后1h～39h出现快速心律失常,其中室上性45例,恶性室性心律失常13例。恶性室性心律失常患者首先予心脏复苏,成功后给可达龙75～150mg静脉推注一次,15min推完。可达龙600mg稀释至50ml静脉泵入。室上性室性心律失常用法同前。用药的同时监测有创动脉压、心率、中心静脉压、指脉氧饱和度、电解质,必要时检测左房压,并定时检查动脉血气。结果 45例室上性室性心律失常29例转为窦性心律,12例心室律控制,4例加用β受体阻断剂后心室律控制;13例恶性室性心律失常患者8例未再发作,3例再发短阵室速经加大胺碘酮用量后控制,2例恶性室性心律失常反复发作,经抢救无效死亡,总有效率88.7%,所有患者无严重的相关并发症。结论盐酸胺碘酮静脉应用对心脏手术后心律失常的治疗安全有效。
Objective To study the effect of intravenous amiodarone hydrochloride (up to dragon) on the incidence of cardiac arrhythmia after cardiopulmonary bypass and on arrhythmogenic mortality. Methods A retrospective analysis of 58 cases of cardiac arrhythmia treated with amiodarone in our department from January 2008 to February 2012 was performed. This group are adult patients, aged 18 to 76 years old, after admission to a clear diagnosis, adequate preoperative preparation of cardiac surgery, 1h ~ 39h after the emergence of tachyarrhythmia, including supraventricular 45 cases of malignant ventricular arrhythmias 13 cases. Patients with malignant ventricular arrhythmias first heart resuscitation, after the success of up to the dragon 75 ~ 150mg intravenous injection, 15min push finished. Up to 600mg dilute to 50ml intravenous infusion. Supraventricular ventricular arrhythmias used with the previous. At the same time monitoring medication with arterial pressure, heart rate, central venous pressure, refers to the pulse oxygen saturation, electrolyte, if necessary, detect the left atrial pressure, and regular check arterial blood gas. Results Forty-five cases of supraventricular tachyarrhythmia were converted to sinus rhythm, 12 cases of ventricular control, 4 cases of β-blocker plus ventricular control, and 13 cases of malignant ventricular arrhythmias Re-attack, 3 cases of recurrent episodes of ventricular tachycardia increased by the amount of amiodarone control, 2 cases of recurrent ventricular arrhythmia, died of rescue invalid, the total effective rate was 88.7%, all patients without serious complications . Conclusion Intravenous administration of amiodarone hydrochloride is safe and effective in the treatment of cardiac arrhythmia after cardiac surgery.