Ovrum E, Tangen G, Holen E A, Ringdal M A, Istad R
Department of Cardiac Surgery, Oslo Heart Center, Norway.
Ann Thorac Surg. 1995 Jul;60(1):156-9. doi: 10.1016/s0003-4975(95)00327-4.
Ventricular fibrillation after declamping of the aorta after cardioplegic arrest is commonly managed by direct-current countershock. However, in coronary artery bypass grafting, placement of the electrodes can cause mechanical damage to the grafts and anastomoses, and the surgical procedure must be interrupted. As an alternative, intraaortic infusion of potassium chloride through the arterial line from the heart-lung machine was investigated.
In a series of 100 patients with postischemic ventricular fibrillation (group P), 20 mmol of potassium chloride (plus 10 mmol later if necessary) was added to the oxygenator reservoir and perfused through the arterial line into the proximal aorta. The results were compared with those in a matched control group of 100 patients primarily treated with direct-current countershock (group DC).
In group P, the ventricular fibrillation was effectively converted to a supraventricular rhythm in 82% of the patients. The remaining 18 patients required significantly (p < 0.005) fewer electric shocks than the patients in group DC. Serum K+ levels were slightly elevated for a short period after the potassium chloride infusion. Otherwise there were no significant differences in regard to incidence of heart block, temporary epicardial pacing, myocardial infarction, or atrial fibrillation between the two groups.
Conversion of postischemic ventricular fibrillation with potassium chloride administered through the arterial line from the heart-lung machine is an effective, gentle, and convenient method. No side effects were noted.
心脏停搏后主动脉开放时发生的心室颤动通常采用直流电除颤进行处理。然而，在冠状动脉旁路移植术中，电极的放置可能会对移植物和吻合口造成机械损伤，且手术过程必须中断。作为一种替代方法，研究了通过心肺机的动脉管路向主动脉内输注氯化钾。
在一系列100例缺血后心室颤动患者（P组）中，将20 mmol氯化钾（必要时稍后再加10 mmol）加入氧合器储液器中，并通过动脉管路灌注至主动脉近端。将结果与100例主要接受直流电除颤治疗的匹配对照组患者（DC组）的结果进行比较。
在P组中，82%的患者心室颤动有效转为室上性心律。其余18例患者所需的电击次数明显（p<0.005）少于DC组患者。输注氯化钾后短时间内血清钾水平略有升高。除此之外，两组在心脏传导阻滞、临时心外膜起搏、心肌梗死或心房颤动的发生率方面无显著差异。
通过心肺机的动脉管路给予氯化钾来转复缺血后心室颤动是一种有效、温和且方便的方法。未观察到副作用。
