McIntosh-Yellin N L, Drew B J, Scheinman M M
Department of Physiological Nursing, University of California, San Francisco.
J Am Coll Cardiol. 1993 Sep;22(3):741-5. doi: 10.1016/0735-1097(93)90185-4.
This study was done to quantify the dosing differences between central and peripheral adenosine administration for treatment of supraventricular tachycardia.
Earlier studies that evaluated the safety and efficacy of adenosine primarily utilized a peripheral site of administration. Although it has been recommended that lower doses should be given centrally, dosing recommendations have not been provided.
Thirty adults with supraventricular tachycardia underwent invasive electrophysiologic study and were treated with central and peripheral intravenous administration of adenosine. Peripheral injections were administered through a venous catheter in an upper extremity and central infusions were accomplished by means of a catheter positioned in or near the right atrium. The site of administration was randomized and each subject received adenosine by both routes. Adenosine was administered every minute in increasing increments of 3, 6, 9 and 12 mg until the tachycardia terminated. Peripheral responses were compared with those obtained centrally.
The minimal effective peripheral dose was distributed among the four doses: Tachycardia was terminated in 11 patients with 3 mg (37%), in 10 (33%) with 6 mg, in 4 (13%) with 9 mg and in 5 (17%) with 12 mg. In contrast, after central administration, 23 episodes of tachycardia (77%) were terminated with 3 mg, 6 (20%) with 6 mg and 1 (3%) with 9 mg; none required 12 mg. Lower doses of adenosine were more effective after central than after peripheral administration, with 63% of the subjects requiring a lesser dose. There was no difference between the two routes of drug administration in the incidence of side effects or transient arrhythmias at the time of tachycardia termination.
Adenosine can be safely given centrally for termination of supraventricular tachycardia. The initial dose should be 3 mg.
本研究旨在量化治疗室上性心动过速时中心静脉与外周静脉给予腺苷的剂量差异。
早期评估腺苷安全性和有效性的研究主要采用外周给药途径。尽管有人建议中心静脉给药时应使用较低剂量，但尚未给出具体的给药建议。
30例室上性心动过速成人患者接受了有创电生理研究，并分别通过中心静脉和外周静脉给予腺苷进行治疗。外周注射通过上肢静脉导管进行，中心静脉输注则通过置于右心房内或其附近的导管完成。给药部位随机分配，每位受试者均接受两种途径给药。腺苷以每分钟递增3、6、9和12mg的剂量给药，直至心动过速终止。比较外周给药与中心静脉给药的反应。
外周给药的最小有效剂量分布在四个剂量组中：11例患者（37%）静脉注射3mg后心动过速终止，10例（33%）静脉注射6mg后终止，4例（13%）静脉注射9mg后终止，5例（17%）静脉注射12mg后终止。相比之下，中心静脉给药后，23例心动过速发作（77%）在给予3mg后终止，6例（约20%）在给予6mg后终止，1例（3%）在给予9mg后终止；无人需要12mg。中心静脉给药后较低剂量的腺苷比外周给药更有效，63%的受试者所需剂量更小。两种给药途径在心动过速终止时的副作用或短暂性心律失常发生率方面无差异。
腺苷可安全地通过中心静脉给药以终止室上性心动过速。初始剂量应为3mg。
