Sakai Hiroaki, Igarashi Kaigen, Imai Mina, Miura Kunihisa, Kanai Masanori, Okazaki Atsushi
Department of Anesthesiology, Juntendo University Izunagaoka Hospital, Shizuoka 410-2295.
Masui. 2004 May;53(5):555-8.
A 62-year-old man complicated with old antero-septal wall myocardial infarction and atrial fibrillation suffered from lung and pancreas cancer. He underwent gastro-duodenum bypass surgery under epidural combined with general anesthesia. His ECG and echocardiogram revealed atrial fibrillation and his left ventricular ejection fraction was 35%. After the start of surgery under general anesthesia, EHR was stable between 80-100 beats x min(-1) but rapid atrial fibrillation developed with a rate of over 140 beats x min(-1) after epidural injection of 0.375% ropivacaine 3 ml. Treatment including continuous intravenous diltiazem and several bolus intravenous injections of verapamil failed to decrease the heart rate. Therefore we used landiolol, a short-acting beta blocker, to control heart rate. HR decreased without decreasing his blood pressure. Continuous landiolol infusion was maintained for 3 hours and 30 minutes in the ICU. After finishing infusion, his heart rhythm never became rapid atrial fibrillation. We conclude that landiolol is useful for heart rate control of rapid atrial fibrillation.
一名62岁男性，患有陈旧性前间隔壁心肌梗死和心房颤动，同时患有肺癌和胰腺癌。他在硬膜外联合全身麻醉下接受了胃十二指肠旁路手术。他的心电图和超声心动图显示为心房颤动，左心室射血分数为35%。全身麻醉开始后，心率在80 - 100次/分钟之间稳定，但在硬膜外注射3毫升0.375%罗哌卡因后，出现快速心房颤动，心率超过140次/分钟。包括持续静脉注射地尔硫䓬和多次静脉推注维拉帕米在内的治疗未能降低心率。因此，我们使用短效β受体阻滞剂兰地洛尔来控制心率。心率下降但血压未降低。在重症监护病房持续输注兰地洛尔3小时30分钟。输注结束后，他的心律再也没有变为快速心房颤动。我们得出结论，兰地洛尔对控制快速心房颤动的心率有用。
