Suzuki Satoshi, Iwasaki Tatsuo, Morimatsu Hiroshi, Yokoi Nagisa, Matsuoka Mayuko, Suemori Tomohiko, Kanazawa Tomoyuki, Shimizu Kazuyoshi, Toda Yuichiro, Morita Kiyoshi
Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama 700-8558.
Masui. 2010 Oct;59(10):1266-70.
Amiodarone is widely used in Europe and the United States for refractory ventricular fibrillation (VF) in various situations, such as VF after myocardial infarction or out-of-hospital cardiac arrest. We report a case of successful treatment with amiodarone of refractory VF immediately after releasing aortic cross-clamp in cardiac surgery. A 66-year-old man suffering from severe aortic stenosis underwent aortic valve replacement (AVR). General anesthesia was induced with propofol and remifentanil, and subsequently AVR was performed under cardiopulmonary bypass. Just after releasing aortic cross-clamp, VF occurred, and it continued despite multiple trials of cardioversion with direct current (DC) shocks of 20 J or 30 J. Furthermore, some DC shocks of 30 J or 50 J after administering lidocaine 60 mg and 0.5 mol x l(-1) magnesium sulfate 20 ml were also ineffective. Then, nifekalant 20 mg was administered and DC shocks of 50 J were repeated intermittently, but VF still persisted. Eventually, VF disappeared after a final DC shock of 50 J with intravenous amiodarone 125 mg. Overall duration of VF was 60 minutes. The patient's trachea was extubated three days after the surgery without any complications. Intravenous amiodarone may be one of the most useful remedies for some types of arrhythmias including persistent VE.
胺碘酮在欧洲和美国被广泛用于各种情况下的难治性室颤（VF），例如心肌梗死后的室颤或院外心脏骤停。我们报告了一例在心脏手术中松开主动脉夹闭后立即用胺碘酮成功治疗难治性室颤的病例。一名患有严重主动脉瓣狭窄的66岁男性接受了主动脉瓣置换术（AVR）。用丙泊酚和瑞芬太尼诱导全身麻醉，随后在体外循环下进行AVR。刚松开主动脉夹闭后，就发生了室颤，尽管多次尝试用20 J或30 J的直流电（DC）电击进行复律，但室颤仍持续。此外，在给予60 mg利多卡因和20 ml 0.5 mol·L⁻¹硫酸镁后，一些30 J或50 J的DC电击也无效。然后，给予20 mg尼非卡兰并间歇性重复50 J的DC电击，但室颤仍然持续。最终，在静脉注射125 mg胺碘酮并进行最后一次50 J的DC电击后，室颤消失。室颤的总持续时间为60分钟。患者术后三天气管拔管，无任何并发症。静脉注射胺碘酮可能是包括持续性室颤在内的某些类型心律失常最有用的治疗方法之一。
