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静脉注射地尔硫对心功能的影响 |
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向晓平 胡大一 洪和秀 崔亮 刘岩 刘士英 顼志敏
【摘要】 目的 评价静注地尔硫对心功能的影响，了解其临床安全性。方法 123例病人分为两组：Ⅰ组室上性快速心律失常90例，Ⅱ组不稳定心绞痛33例。分别静脉注射地尔硫0.3mg.kg-1.min-1(Ⅰ组)和0.2mg.kg-1.min-1(Ⅱ组)。分别在给药前，后进行心电图、血压监测及观察临床表现。并对Ⅰ组30例，Ⅱ组6例，心功能Ⅱ～Ⅲ级患者采用Swan-Ganz漂浮导管监测，给药前及给药后30、120分钟血流动力学变化。结果 两组给药后心室率下降最大效应时间为15分钟。Ⅰ组临床心悸等症状缓解时间平均为15分钟，Ⅱ组心绞痛缓解平均为20分钟。心室率平均下降幅度：Ⅰ组为34次/分(P<0.05)，Ⅱ组为26次/分(P<0.05)。血流动力学：除Ⅰ组心输出量平均增加0.56L/min(P<0.05)外，其它参数指标P值均>0.05，无统计学意义。结论 静注地尔硫0.2～0.3mg.kg-1.5min-1，能快速有效地控制心房颤动心室率，室上性快速心律失常及不稳定心绞痛，且不会引起或加重心功能障碍。
【关键词】 心力衰竭 地尔硫
Influence of intravenous diltiazem on heart fuction Xiang Xiaoping*, Hu Dayi**, Hong Huoxiu*, et al.*Cardiovascular Center, The Sixth Hospital of Beijing, Beijing 100007;**Institute of Cardiovascular Disease, Capital University of Medical Sciences, Beijing 100020
【Abstract】 Objective To observe the influence of intravenous diltiazem on heart fuction. Methods Ninety patients of supraventricular tachycardia (group Ⅰ) and 33 of unstable angina pectoris (group Ⅱ) were studied by measuring hemodynamics, ECG and BP after intravenous diltiazem of 0.3 mg/kg/5min (group Ⅰ) and 0.2 mg/kg/5min (group/Ⅱ). Results The maximum peak time of therapeutic effect was 15 min (group Ⅰ and Ⅱ). The mean relief times of palpitation in group Ⅰ and angina in group Ⅱ were 15 and 20 min, respectively after intravenous diltiazem. The mean decline of ventricular rate was 34 beats/min (group I, P<0.05) and 26 beats/min (group Ⅱ, P<0.05). The mean reduction of BP was 8/5mmHg (group Ⅰ, P>0.05 ) and 7/5mmHg (group Ⅱ, P>0.05). Changes of the hemodynamic parameters measused were statistically insignificant except the mean increase of CO was 0.56L/min in group Ⅰ (P<0.05). Conclusion Intravenous diltiazem is effective and safe to slow down ventricular response of atrial fibrillation to treat supraventricular tachycardia and unstable angina pectoris without initiating or aggravating cardiac dysfunction.
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