Janeira L F
Ohio Valley HeartCare, Evansville, Indiana, USA.
Am Fam Physician. 1996 Oct;54(5):1573-84.
Wide complex tachycardias are cardiac rhythm disorders with three or more consecutive beats, rates exceeding 100 beats per minute and a QRS duration of 120 msec (0.12 second) or greater. The width of the QRS complex should be verified in a number of leads, since the QRS complex often appears mistakenly narrower (i.e., a QRS duration of less than 120 msec) in one or two of the 12 leads. Most wide complex tachycardias are ventricular tachycardia, and they are managed with antiarrhythmic drugs and correction of serum potassium and magnesium levels. Electrical cardioversion/defibrillation may be used in patients with serious cardiac compromise. Supraventricular tachycardias occur with or without ventricular conduction abnormalities. The management of supraventricular tachycardia requires careful evaluation for aberrant ventricular conduction or preexcitation. The cause of a wide complex tachycardia must be identified, because certain therapies can result in potentially fatal arrhythmias. If the cause cannot be determined, a test dose of intravenous adenosine can be used. Another approach is intravenous administration of procainamide and a beta-adrenergic blocker.
宽QRS波心动过速是一种心律失常，具有三个或更多连续的心搏，心率超过每分钟100次，QRS波时限为120毫秒（0.12秒）或更长。应在多个导联中确认QRS波群的宽度，因为在12导联中的一两个导联中，QRS波群常常会错误地显得更窄（即QRS波时限小于120毫秒）。大多数宽QRS波心动过速为室性心动过速，可使用抗心律失常药物并纠正血清钾和镁水平进行治疗。对于有严重心脏功能不全的患者，可使用电复律/除颤。室上性心动过速可伴有或不伴有心室传导异常。室上性心动过速的治疗需要仔细评估是否存在异常心室传导或预激。必须确定宽QRS波心动过速的病因，因为某些治疗可能会导致潜在的致命性心律失常。如果病因无法确定，可使用静脉注射腺苷试验剂量。另一种方法是静脉注射普鲁卡因胺和β肾上腺素能阻滞剂。
