论文部分内容阅读
目的探讨院内获得性尖端扭转型室性心动过速(Tdp)的临床特点。方法回顾性分析2009-2014年首都医科大学良乡教学医院心内科监护病房(CCU)明确诊断为院内获得性Tdp患者(19例)的临床资料,收集年龄、性别、基础疾病、家族史等,治疗过程中应用的药物、生化、心电图变化,发生Tdp后治疗方法及效果。结果 1例因服红霉素过量引起,3例冠心病并心绞痛,3例急性心肌梗死急性期,12例为心功能不全。4例应用抗菌药物,5例应用胺碘酮,12例应用利尿剂。所有病例心电图示QT间期延长,低血钾10例,低血镁7例。所有患者均给予补镁补钾,必要时电复律,9例给予临时起搏器提高心室率,10例仅药物治疗;与治疗前比较,治疗后血钾[(3.4±0.4)mmol/L vs.(4.7±0.3)mmol/L,P<0.001]及血镁明显提高[(0.8±0.1)mmol/L vs.(1.1±0.1)mmol/L,P<0.001],QT间期[(504.1±19.0)ms vs.(450.0±21.0)ms,P<0.001]及按心率校正的QT间期(QTc)明显缩短[(512.9±12.9)ms vs.(477.1±11.5)ms,P<0.001]。临时起搏器组室速发作、电复律次数低于单纯药物组。18例痊愈,1例死亡。结论院内获得性Tdp是住院患者发生猝死的重要原因,但及时发现可以治愈,对于有器质性心脏病患者安装临时起搏器效果较好。
Objective To investigate the clinical characteristics of acquired torsades de pointes ventricular tachycardia (Tdp) in hospital. Methods The clinical data of 19 patients with acquired Tdp diagnosed in CCU from Liangxiang Teaching Hospital, Capital Medical University from 2009 to 2014 were retrospectively analyzed. The age, gender, underlying diseases and family history were collected. Drugs used in the course of treatment, biochemistry, ECG changes, treatment methods and effects after Tdp occurred. Results One case was caused by overdose of erythromycin, 3 cases of coronary heart disease and angina pectoris, 3 cases of acute myocardial infarction in acute phase and 12 cases of cardiac insufficiency. 4 cases of antibacterial drugs, 5 cases of amiodarone, 12 cases of diuretics. ECG in all cases showed QT prolongation, hypokalemia in 10 cases, hypomagnesemia in 7 cases. All patients were given magnesium supplementation, cardioversion if necessary, 9 cases of temporary pacemaker to improve ventricular rate, 10 cases of drug treatment only; before treatment, serum potassium [(3.4 ± 0.4) mmol / L (P <0.001 vs. P <0.001) and blood magnesium significantly increased (P <0.001) (512.9 ± 12.9) ms vs. (477.1 ± 11.5) ms, P <0.001 for 504.1 ± 19.0 ms vs. 450.0 ± 21.0 ms, P <0.001 and QTc corrected for heart rate, respectively ]. Temporary pacemaker group VT onset, the number of electrical cardioversion was lower than the simple drug group. Eighteen patients recovered and one died. Conclusion Intra-hospital acquired Tdp is an important cause of sudden death in hospitalized patients, but it can be cured in time. It is better for patients with organic heart disease to install temporary pacemaker.