Shettigar U R, Toole J G, Appunn D O
University of South Florida College of Medicine, Cardiology Section, VAMC, Bay Pines 33504.
Am Heart J. 1993 Aug;126(2):368-74. doi: 10.1016/0002-8703(93)91053-h.
Safety and efficacy of simultaneous use of intravenous digoxin and esmolol in the control of rapid heart rate in 21 patients with atrial fibrillation or flutter was assessed. The mean age was 67 (range 40 to 90) years. Seven patients had class III congestive heart failure, with left ventricular ejection fraction between 18% and 61%. Baseline mean heart rate was 143 +/- 4. After 0.25 mg or 0.5 mg intravenous digoxin, esmolol was titrated with initial boluses from 2 mg/min to 16 mg/min in 25 minutes. A tolerated dose of esmolol infusion was adjusted for up to 48 hours. Rapid control of heart rate (29% decrease with heart rate 101 +/- 4) occurred at a mean interval of 21 minutes. Minimum heart rate was 87 +/- 4 at 90 minutes of treatment. Conversion to sinus rhythm occurred in five patients (25%), and one patient experienced mild transient congestive heart failure. No symptomatic hypotension or bronchospasm occurred. In conclusion, simultaneous use of digoxin and esmolol is effective in safely and rapidly controlling heart rate in atrial fibrillation or flutter.
评估了21例心房颤动或心房扑动患者同时使用静脉注射地高辛和艾司洛尔控制快速心率的安全性和有效性。平均年龄为67岁（范围40至90岁）。7例患者患有Ⅲ级充血性心力衰竭，左心室射血分数在18%至61%之间。基线平均心率为143±4。静脉注射0.25mg或0.5mg地高辛后，在25分钟内将艾司洛尔从初始推注量2mg/min滴定至16mg/min。调整艾司洛尔输注的耐受剂量，持续48小时。平均21分钟时心率迅速得到控制（心率下降29%，心率为101±4）。治疗90分钟时最低心率为87±4。5例患者（25%）转为窦性心律，1例患者出现轻度短暂性充血性心力衰竭。未发生症状性低血压或支气管痉挛。总之，地高辛和艾司洛尔同时使用可有效、安全且迅速地控制心房颤动或心房扑动的心率。
