查詢結果分析
來源資料
相關文獻
- Life-Threatening Cardiac Arrhythmia-Torsades de Pointes in the Emergency Department
- 心房纖維顫動(Atrial Fibrillation)的藥物治療
- 抗心律不整藥物
- 心房纖維顫動(Atrial Fibrillation)的藥物療法
- 心律不整
- 變異型心絞痛併房室傳導阻斷:一病例報告
- 心房性心律不整的最新研究及治療
- Cardiac Arrhythmias in Patients Treated for Evolving Myocardial Infarction with Recombinant Tissue Plasminogen Activator
- 腺核苷治療心律不整的基礎及臨床觀點
- Complex Arrhythmia
頁籤選單縮合
題名 | Life-Threatening Cardiac Arrhythmia-Torsades de Pointes in the Emergency Department=在急診部中威脅生命的心律不整--Torsades de Pointes |
---|---|
作者 | 胡松原; 胡為雄; 楊大羽; Hu, Sung-yuan; Hu, Wei-hsiung; Yang, Dar-yu; |
期刊 | 中華民國重症醫學雜誌 |
出版日期 | 20030000 |
卷期 | 5:2 2003[民92.] |
頁次 | 頁110-122 |
分類號 | 415.318 |
語文 | eng |
關鍵詞 | 心律不整; 多形性心室頻脈; Arrhythmia; Polymorphic ventricular tachycardia; Torsades de pointes; |
中文摘要 | 背景:Torsades de pointes (TdP),一種多型性心室心律不整,會惡化成心室顫動和猝死。在急診正確貢斷和處置TdP是拯救急性病患重要的任務。 病患:在臺中榮總急診部近4年,根據臨床表現及心電圖發現共收集7位病患。實驗室檢查包括腎功能和電解質。 結果:3位(42.9%)男性和4位(57.1%)女性,年齡介於30~91(66.0±21.2)歲,其中6位(85.7%)年齡超過50歲。7位(100%)有神經學症狀(頭暈、暈厥、意識混亂、意識喪失),1位(14.3%)低血鈣,2位(28.6%)低血鎂。平均QT及QTc區間明顯延長(表1)。住院日數為3~17(平均7.7±4.6)天。4位(57.1%)因血行動力學不穩定,立即接受去碩,7位皆接受藥物治療,包括硫酸鎂、腎上腺素、lidocaine、isoproterenol及/或aminodarone,3位(42.8%)接受暫時性經靜脈心律調節器之植入。7位病患皆存活,但1位病患住院期間因頭部外傷併顱內出血死亡。 結論:TdP是一種QT區間延長的多形性心室頻脈,通常是醫源性。好發於女性及老人。治療重點在於重建穩定的血行動力學,移除或校正促發因子,並預防再急性發作及長期治療。病患評估包括完整病史、理學檢查、潛在性心臟病及誘發因子之評量。 |
英文摘要 | Background: Torsades de pointes (TdP) is a polymorphic ventricular arrhythmia that can progress to ventricular fibrillation and sudden death. Making the correct diagnosis and management of TdP in the emergency department is an important task for saving critical patients. We analyzed cases of TdP found in the recent 4 years and reviewed the related literature Patients: Seven patients were enrolled by history, clinical manifestations and findings of electrocardiographic recorded in the recent 4 years (from May 1998 to July 2002) in the emergency department. Laboratory studies, including renal function and electrolytes, were collected. Results: There were three (3/7=42.9%) males and four (4/7=57.1%) females in our analysis. the ages ranged from 30 to 91 (66±21.2) years and six patients (6/7=85.7%) were old age more than 50 years. Seven patients (7/7=100%) presented with neurological symptoms including dizziness, syncope, consciousness disturbance and loss of consciousness. One patient had the symptom of palpitation. Laboratory studies revealed four patients (4/7=57.1%) with hypokalemia (potassium <3.5 mEq/L), one patient (1/7=14.3%) with hypocalcemia (calcium <9.0 mg/dL) and two patients (2/7=28.6%)with hypomagnesemia (magnesium <1.7 mg/dL). Both the observed and corrected QT intervals which were 391~840 milliseconds (533.7±151.6) and 437~649 (537.9±83.6) milliseconds, respectively, showed a marked prolongation, indicating that they were predisposing factors of TdP in our repot. All QTc intervals were more than 400 milliseconds in our report. The hospitalizations ranged from 3 to 17 (7.7±4.6) days. All patients survived after management, including 4 patients (4/7=57.1%) receiving immediate defibrillation for hemodynamic instability, intravenous infusion of magnesium, epinephrine, lidocaine, isoproterenol and/or amiodarone. Three patients (3/7=42.7%) received the implantation of temporary transvenous cardiac pacemaker. All patients survived after management except one patient, who expired due to head injury with intracranial hemorrhage after falling down to the ground while going to the toilet during admission. Conclusion: TdP denotes polymorphic ventricular tachycardia in the setting of a prolonged QT interval and usually is iatrogenic in origin, perhaps due to the use of drugs, including diurecties, antihistamine, antibiotics, cimetdine, and fluoxietine, and/or combined electrolyte imbalance, including hypokalemia, hypomagnesemia and hypocalcemia, or underlying heart disease, including 3-degree AV block and congestive heart failure in our repot. Therapy of TdP focuses on the reestabilishment of hemodynamic stability, the removal or correction of precipitants, and the acute and long-term inhibition of subsequent episodes. Evaluation of these patients should include a complete history and physical examination and an assessment for underlying heart disease and know electing factors. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。