【摘要】 目的 评估对于曾有急性心肌梗死的室性心动过速（VT）患者，导管消融（RA）减少植入式心脏转复除颤器（ICD）放电转律治疗的疗效和安全性。 方法 计算机检索Pubmed、EMbase、Cochrane图书馆、中国生物医学文献光盘数据库、中文科技期刊全文数据库、CNKI数字图书馆，纳入RA+ICD和单独使用ICD对比治疗VT患者的随机对照临床试验，对纳入的研究进行质量评价和Meta分析。 结果 共纳入2篇最近发表在国外一流杂志上面的临床随机对照研究，一篇发在《新英格兰杂志》，另外一篇发在《柳叶刀》。RA+ICD组纳入116例患者，其中有23例（20%）因为再发VT或者心室颤动（Vf）而进行了ICD放电转律治疗；ICD组纳入119例患者，其中有49例（41%）因为再发VT或者Vf而进行了ICD放电转律治疗。Meta分析结果显示，RA+ICD的组合相对于单独运用ICD来说，需要进行ICD放电转律治疗的人数较少，OR=0.33，95%CI（0.18～0.61），P=0.000 4。 结论 目前研究认为射频消融可能可减少需进行ICD放电转律治疗的人数，以后需要更多更大样本量的研究进一步证实该结果。【Abstract】 Objective To assess the efficacy and safety of radiofrequency catheter ablation (RA) for the prevention of defibrillator therapy with implantable cardioverter defibrillator (ICD) for patients who have had acute myocardial infarction with ventricular tachycardia (VT). Methods Randomized controlled trials on patients with VT who underwent RA and ICD versus ICD alone were searched from Pubmed, EMbase, the Cochrane Central register of controlled trials, China Biology Medicine database, Chinese Science and Technology Journal database and the CNKI digital library. Quality assessment and Meta analysis were carried out for the researches sought out from these databases. Results Two randomized controlled studies published on The New England Journal of Medicine and the Lancet were included in our study. RA plus ICD were used in 116 cases, among whom 23 underwent ICD shocks due to reoccurrence of VT or ventricular fibrillation (Vf). Single ICD was used in 119 cases among whom 49 underwent ICD shocks due to reoccurrence of VT or Vf The result of Meta analysis showed that the number of patients needing ICD shocks after RA plus ICD treatment was significantly lower than that after single ICD treatment. The statistical data of the comprehensive Meta analysis were OR=0.33, 95%CI (0.18-0.61), and P=0.000 4. Conclusion At present, it is believed that RA can be used for the prevention of defibrillator therapy, while the result should be confirmed by large sample research in the future.
目的探讨成人风湿性心脏瓣膜病术前并发心室电风暴（恶性室性心动过速、心室颤动）行急诊手术的疗效及体会。 方法回顾性分析2004年10月至2014年10月我院成人心脏瓣膜入院后突发恶性室性心动过速、心室颤动的患者6例，其中男2例，女4例，年龄35.0～64.0岁，平均49.8岁。6例患者均为风湿性心脏瓣膜病，二尖瓣中重度狭窄并主动脉瓣及三尖瓣中重度关闭不全2例，二尖瓣中重度关闭不全并三尖瓣中重度关闭不全4例，恶性心律失常发作后立即予艾司洛尔等药物控制，病情基本稳定后急诊手术。其中，行双瓣膜置换+三尖瓣成形术2例，行二尖瓣置换+三尖瓣成形术4例。 结果无围术期患者死亡，术后无心功能显著恶化、无多脏器功能衰竭、无恶性室性心律失常。术后1～2周24 h动态心电图提示室性早搏大于1 000次的2例，室性早搏500～1 000次1例，小于500次的患者3例，短阵室性心动过速2次的患者2例，短阵室性心动过速3次的患者1例。所有6例患者均安全出院，随访6个月至10年，无患者死亡。 结论急诊外科手术联合β受体阻滞剂在治疗成人心脏瓣膜疾病术前突发的反复恶性室性心动过速、心室颤动安全有效。
American Heart Association (AHA) updated the advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest in the AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care in November 2018. Based on the latest progress of relative evidence-based clinical evidence and 2015 AHA guidelines for cardiopulmonary resuscitation and cardiovascular emergency cardiovascular care. This update gave recommends on the use of antiarrhythmic drugs during resuscitation from adult shock-refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest and immediately after restoration of spontaneous circulation following shock-refractory VF/pVT cardiac arrest, respectively. This review aims to interpret this update by reviewing the literature and comparing the recommends in this update with other guidelines.