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我院遇见2例多形性室速伴发于极短联律间距。现报道如下。 例1:女,32岁。反复发作胸闷、心悸、晕厥4年,加重1天于1992年11月28日入院。过去曾因频发室早、短串室速,在外院滴注利多卡因、美西律、维拉帕米治疗,症状控制出院。本次因ECG示频发室早、短串室速(多形性)入院。体检;BP16.5/10.8kPa。神清,心界不大,心率90次/分,早搏10～12次/分,闻短串心动过速,无杂音。血、尿常规,ASO、ESR、血电解质、多次心肌酶谱(SGOT,LDH,CK,CKMB)检测均正常。X线心脏MB三位片、二维MB、彩色多普勒及左心室超声动静态三维图象再建检查亦正常。ECG示窦性心律,频发室早(RonT)短联律间距(280ms),Q-T间期0.38s,短串室速。入院后静滴利多卡因、美西律、胺碘酮均无效。心电监护:频发室早伴极短联律间距,室速发作时室率280次/分,频发晕厥。发作间歇期为基本心律时T波与U波形态及Q-T间期正常。半小时内连续3次静推维拉帕米总量15mg后室速控制,继以15μg/min维持。1周后改为120mg,每8小时1次口服。曾试验性停药不足24小时,上述症状复发,再以维拉帕米控制,1个月后出院,目前已出院随访17个月,维拉帕米仍360mg/d口服。情况良好,但不能减量。
My courtyard met two cases of pleomorphic ventricular tachycardia accompanied by extremely short joint distance. Report as follows now. Example 1: Female, 32 years old. Repeated chest tightness, palpitations, syncope 4 years, one day heavier on November 28, 1992 admission. In the past due to frequent premature ventricular tachycardia, short ventricular tachycardia, intravenous infusion of lidocaine in the outer hospital, mexiletine, verapamil treatment, the symptoms were discharged. The frequency of this room for ECG showed early, short-term VT (pleomorphic) admission. Physical examination; BP16.5 / 10.8kPa. God clear, heart is not big, heart rate 90 beats / min, premature beats 10 to 12 beats / min, smell short strings of tachycardia, no noise. Blood, urine routine, ASO, ESR, blood electrolytes, multiple myocardial enzymes (SGOT, LDH, CK, CKMB) were normal. X-ray MB three-slice, two-dimensional MB, color Doppler and left ventricular ultrasound dynamic and static three-dimensional image reconstruction examination is also normal. ECG showed sinus rhythm, frequent ventricular tachycardia (RonT) short joint distance (280ms), Q-T interval 0.38s, short-term VT. Intravenous infusion of lidocaine, mexiletine, amiodarone were ineffective. ECG monitoring: frequent room early with very short joint spacing, ventricular tachycardia rate of 280 beats / min, frequent syncope. Seizure interval as the basic rhythm T wave and U wave morphology and Q-T interval is normal. After three hours in a half hour, the total volume of verapamil was 15mg and the ventricular tachycardia was maintained, followed by 15μg / min. 1 week later changed to 120mg, every 8 hours 1 times orally. Have experimental withdrawal less than 24 hours, the recurrence of symptoms, then verapamil control, 1 month after discharge, has been discharged for 17 months, verapamil is still 360mg / d orally. In good condition, but can not be reduced.