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升压药物一般认为只对室上性心动过速有效。本文报告用升压药物苯肾上腺素使5例反复发作的室性心动过速(其临床表现见表)终止,其中3例以后转为持续的窦性心律,另2例只有暂时的效果。苯肾上腺素的剂量为1～3毫克静注。这些病人亦曾用按摩颈动脉窦或并用艾亩酚(Edrophenium,Tensilon)10～15毫克静注来治疗,但只能使室性心动过速的房室脱节中的心房率变慢,或使其逆行传导阻滞,而对心室的活动性能无作用。若用咽鼓管通气方法或合用阿托品2.4毫克静注,可使其中3例的室性心动过速暂停。用利多卡因100～300毫克静注,只1例偶然有效。苯肾上腺素终止室性心动过速的机理尚未明瞭,可能与胆硷能和非胆硷能的作用有关,后者的机理可能是:(1)升压作用使心室内膜和心肌传导纤维牵张,引起膜电位消失及其传导性改变;(2)血压升高使心脏的交感神经兴奋的反射性减弱;(3)直接的膜效应;(4)升压作用使区域性冠状动脉血流改变。作者认为:(1)苯肾上腺素可有效地终止某些室性心动过速;(2)苯肾上腺素和可能由其他升压药物所终止的某些规则的、QRS波群增宽的心动过速,不能看成是室上性心动过速的明证。
Vasopressors are generally considered effective only for supraventricular tachycardia. This report reports the termination of 5 recurrent ventricular tachycardias with phenylephrine, a vasopressor drug, whose clinical manifestations terminate in 3 of them, followed by a continuous sinus rhythm, and the other 2 with a temporary effect. Phenylephrine dose of 1 to 3 mg intravenously. These patients have also been treated with carotid sinus massage or with intravenous injection of 10-15 mg of Edrophenium (Tensilon), but only by slowing the atrial rate in ventricular tachycardia Its retrograde conduction block, while the activity of ventricular function has no effect. If the Eustachian tube ventilation method or combination of atropine 2.4 mg intravenous injection, which can be 3 cases of ventricular tachycardia suspended. Lidocaine 100 ~ 300 mg intravenous injection, only 1 case by chance effective. The mechanism by which phenylephrine stops ventricular tachycardia is unclear and may be related to the effects of cholinergic and non-cholinergic energy. The mechanism of this latter mechanism may be: (1) the action of increasing pressure on the ventricular and cardiac conduction fibers Zhang, causing the disappearance of membrane potential and changes in its conductivity; (2) elevated blood pressure so that the reflex of the sympathetic nerve of the heart weakened; (3) the direct membrane effect; (4) the role of regional pressure to make regional coronary blood flow change. The authors suggest that: (1) phenylephrine is effective in terminating certain ventricular tachycardia; (2) phenylephrine and certain regular QRS complex-widened tachycardia that may be stopped by other vasopressors Speed, can not be seen as evidence of supraventricular tachycardia.