【摘要】 目的　介绍胺碘酮静脉和口服应用治疗大左心室合并心力衰竭患者室性心律失常的临床应用经验。方法　 12 0例不同病因的器质性心脏病患者 ,男性 6 4例 ,女性5 6例 ,平均年龄 ( 4 5 9± 13 2 )岁 ,其中风湿性心脏瓣膜病 4 2例 ,先天性心脏病 18例 ,扩张型心肌病 37例 ,缺血性心脏病2 3例 ,左心室舒张末内径 7 0cm以上 ,合并心力衰竭及室性心律失常。静脉给药方法 :胺碘酮首剂 15 0mg ,10min注入 ,第 1次负荷量后心律失常控制不理想 ,可追加一次 15 0mg剂量 ,继之以 0 4 5～ 1 5mg/min维持泵入 ,第 1个 2 4小时静脉胺碘酮总量为 ( 95 6 5± 14 3 3)mg ,同时加用口服胺碘酮 ,静脉泵入时间为 ( 3 6± 2 4 )d。结果　对室性心律失常总有效率 83 5 % ,持续性室性心动过速终止率为 2 8 7% ,副作用 :8例出现窦性心动过缓 ,减量后恢复。一过性Ⅱ度房室传导阻滞 4例。静脉炎 2 3例 ,1例发生尖端扭转型室速 ,严重低血压反应者 6例 ,经多巴胺升压处理后稳定。未见甲状腺功能相关影响。结论　胺碘酮治疗不同病因引起的巨大左心室合并心力衰竭患者的室性心律失常安全有效。更多还原

【Abstract】 Objectives To observe the effects of amiodarone (intravenous and oral) on ventricular arrhythmias in patients with heart failure and large left ventricle. Methods 120 consecutive patients with organic heart disease and left ventricular end diastolic dimension >7 0 cm were studied, 64 males, 56 females, age (45 9±13 2) years. Medical history included rheumatic heart disease in 42, congenital heart disease in 18, idiopathic dilated cardiomyopathy in 37 and ischemia cardiomyopathy in 23. All patients treated with loaded intravenous amiodarone 150～300 mg, and then pumped 0 45～1 5 mg/min, the mean dose was (956 5±144 3) mg at the first day, infusion was maintained for (3 6±2 4) days, and united oral amiodarone simultaneously Results The termination rate of ventricular tachycardia by amiodarone was 28 7%, the total success rate, defined as disappea rance of the arrhythmia, was 83 5%. During amiodarone therapy, 8 patients developed sinal bradycardia and recovered after decrease of amiodarone, transient atrio-ventricular block Ⅱ° was seen in 4 patients, Phlebitis occurred in 23 patients, 1 patient had Torsade de pointes, severe hypotension occurred in 6 patients and recovered after treatment with dopamine. The thyroid function had not been influenced in all patients.Conclusions Amiodarone can be used safely and effectively for ventricular arrhythmias in patients with heart failure and large left ventriccle.更多还原