β受體阻滯劑在惡性心律失常搶救中的療效觀察

[摘要] 目的 觀察β受體阻滯劑在惡性心律失常中的臨床效果。方法 23例室速、室顫（AF）病例均為中山市東鳳醫院和廣州珠江醫院急診內科2004年11月～2007年6月就診患者，一組在規范的搶救基礎上靜脈注射應用倍他樂克5～15mg和電擊除顫。結果 5例予靜注倍他樂克5mg加除顫1次即成功復律并維持竇律；10例靜注倍他樂克10mg加除顫2次成功復律并維持竇律；2例靜注倍他樂克15mg加除顫3次成功復律并維持竇律；6例死亡。總有效率為73.9%，顯效21.7%，無效26.1%。結論 β受體阻滯劑在惡性心律失常中的臨床效果顯著。

[關鍵詞] β受體阻滯劑； 惡性心律失常

[中圖分類號] R541.7 [文獻標識碼] A [文章編號] 1673-9701（2009）13-65-02

The Clinical Effect of Adrenergic Receptor Blocker in M align Arrhythmia

LIU Jianyao YIN Xueliang LIANG Tianshu

Department of Internal Medicine，Dongfeng Hospital of Zhongshan City，Guangdong 528425

[Abstract] ObjectiveTo observethe clinical effect of adrenergic receptor blockers in maligant arrhythmia. MethodsAll 23 cases of AF were injected betaloc 5～15mg and electrical shock. Results5 cases after being injected 5mg beta blocker and one shock were succeedly renewed sinoatrial rhyrhm；10 cases after being injected 10mg betaloc and 2 shock were succeedly renewed sinoatrial rhyrhm；2 cases after being injected 15mg betaloc and 3 shock were succeedly renewed sinoatrial rhyrhm，there were 6 cases of death. The total effect was 73.9%，the evident effect was 21.7%，there was 26.1% of invalidation rate. ConclusionThe clinical effect of maligant arrhyrhrmia after being injected adrenergic receptor blockers is obvious.

[Key Words]Adrenergic receptor blockers； Maligant arrhythmia

β受體阻滯劑在急性心肌缺血、心力衰竭（簡稱心衰）、高血壓、肥厚型梗阻性心肌病等多種重要而常見的心血管疾病中的應用與研究十分廣泛，應用地位日趨重要，已成為上述多種心血管疾病的一線用藥和基礎用藥。β受體阻滯劑對這些心血管疾病的危險事件、總死亡率的降低與控制起到了不可低估的作用。相比之下，臨床醫師對β受體阻滯劑在心律失常治療中的重要作用缺乏深刻的理解和認識，使其在臨床的廣泛應用受到了束縛和限制。我們在搶救1例急性廣泛前壁心肌梗死合并反復發作室性心動過速和心室顫動過程中，經電除顫37次并大量應用利多卡因、胺碘酮后，嘗試靜注倍他樂克（美托洛爾）針10mg， 30min內未再發作，之后再發時又靜注倍他樂克針10mg，室性心動過速和心室顫動完全終止，未再發作。由此我們得到啟示，美托洛爾對室速、室顫的終止可能會有舉足輕重的作用。……