[药物治疗房颤伴心动过速后发生的心源性休克：一名89岁女性的病例报告]

[Cardiogenic shock after drug therapy for atrial fibrillation with tachycardia : Case report of an 89-year-old woman].

作者信息

Fey H, Jost M, Geise A T, Bertsch T, Christ M

机构信息

Universitätsklinik für Notfall- und Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg, Klinikum Nürnberg, Prof. Ernst Nathan Str. 1, 90419, Nürnberg, Deutschland.

Institut für Klinische Chemie, Laboratoriumsmedizin und Transfusionsmedizin - Zentrallaboratorium, Paracelsus Medizinische Privatuniversität, Nürnberg, Nürnberg, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2016 Jun;111(5):458-62. doi: 10.1007/s00063-015-0089-9. Epub 2015 Oct 6.

DOI:10.1007/s00063-015-0089-9

PMID:26440099

Abstract

β-Blockers and calcium channel blockers are commonly used drugs in the treatment of atrial fibrillation with tachycardia. However, in patients with high myocardial susceptibility and vulnerability, combination therapy with β-blockers and non-dihydropyridine calcium channel blockers (verapamil or diltiazem) but also individual administration can cause drug-induced cardiogenic shock. Thus, the simultaneous administration of β-blockers and non-dihydropyridine calcium channel blockers is absolutely contraindicated. In case of acute heart failure, isolated application is also contraindicated. In the treatment of a cardiogenic shock induced by β-blockers and/or non-dihydropyridine calcium channel blockers, administration of intravenous calcium, glucagon or high-dose insulin is recommended.

摘要

β受体阻滞剂和钙通道阻滞剂是治疗伴有心动过速的心房颤动的常用药物。然而，在心肌易感性和脆弱性较高的患者中，β受体阻滞剂与非二氢吡啶类钙通道阻滞剂（维拉帕米或地尔硫䓬）联合治疗以及单独使用均可能导致药物性心源性休克。因此，β受体阻滞剂与非二氢吡啶类钙通道阻滞剂同时给药是绝对禁忌的。在急性心力衰竭的情况下，单独使用也是禁忌的。在治疗由β受体阻滞剂和/或非二氢吡啶类钙通道阻滞剂引起的心源性休克时，建议静脉注射钙剂、胰高血糖素或大剂量胰岛素。