抗心律失常药物也会诱发心律失常吗?

2024-12-01 01:45:43
推荐回答(1个)
回答1:

冠心病病人使用抗心律失常药十分普遍,抗心律失常治疗的目的是:
(1)防止猝死,某些动态心电图记录表明患者猝死前常有严重的心律失常发生;
(2)改善血液循环状态,因为如果心室和心房收缩顺序改变,能使心排血量下降。
(3)减轻或消除症状,如心慌、气短、头昏、头晕、晕厥及严重的心功能障碍等。
尽管抗心律失常治疗会有以上疗效,但同时应注意,抗心律失常药均有潜在的致心律失常作用,有人认为抗心律失常作用愈强,致心律失常作用的可能性愈大。当患者心力衰竭或低血钾、低血镁时,引起严重的或威胁生命的心律失常的可能性增大。目前应用的抗心律失常药物有四大类,但这四大类在抗心律失常的同时均有不同程度诱发心律失常的作用,特别是I类抗心律失常药物诱发心律失常率高达13%。
此外,有些抗心律失常药物还可引起血液流变学改变,血小板减少;抗心律失常的常用药物乙胺碘伏酮可使10%的患者发生肺纤维化;而慢心律对肝脏有一定的损害。临床上比较重视的是抗心律失常药物的负性肌力作用,因为负性肌力作用引起的左室功能减退正是猝死的最主要危险。
综上所述,患者在使用某一抗心律失常药物之前,除应考虑该药的有效性和危害性之外,在服药期间还应常规进行心电图检测,尤其是24小时动态心电监测,并应定期对血液生化、肝肾功能进行检查。当心律失常得到基本控制后,应逐渐减量直至停药。一般来说,抗心律失常药物是不宜长时间服用的,当然,具体的治疗意见应听从医生的建议。

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