临床必备！8 类心血管急救药物用法全面汇总

2021-12-26 中国医学论坛报今日循环中国医学论坛报今日循环

两条咸鱼

陕西省西安市中心医院医生/ 医师

心血管急症具有发病急、病情复杂、危重等特点，在临床中，心血管急症的救治药物的应用起着关键性作用。

心血管急症具有发病急、病情复杂、危重等特点，在临床中，心血管急症的救治药物的应用起着关键性作用。

因此，熟练掌握心血管急救药物的使用至关重要，是临床医生抢救患者成功的制胜法宝。8 类心血管急救药物用法一览，一起来看看吧~

肾上腺素（副肾）

作用及用途：

为肾上腺受体兴奋剂，兴奋心脏，使血管收缩、血压升高，又可使支气管平滑肌弛缓并减少支气管黏膜及充血，用于心脏骤停，过敏性休克，支气管哮喘。

抢救过敏性休克

皮下注射或肌注0.5～1 mg，也可用0.1～0.5 mg缓慢静注（以0.9%氯化钠注射液稀释到10 ml）。如疗效不好，可改用4～8 mg静滴（溶于5%葡萄糖液500～1000 ml）。

抢救心脏骤停

可用0.5～1 mg立即静注，可每隔3～5 min重复应用数次。必要时以0.25～0.5 mg心内注射，同时作心脏按摩、人工呼吸和纠正酸中毒。

对非心脏骤停者（如感染性休克和有症状的窦性心动过缓）

肾上腺素也可作为升压药和正性频率药使用，但此时肾上腺素并非首选药，用量一般为0.1～2 μg/kg/min，配置方法以公斤体重×0.3配制成50 ml微量泵，以1 ml/h速度泵入相当于0.1 μg/ kg/min，用量范围为1～20 ml/h。如60 kg患者，配置方法为18 mg（18支）＋0.9%NS 32 ml配制成50 ml微量泵，1 ml/h＝0.1 μg/kg/min。

用量范围：

1～20 ml/h＝0.1～2 μg/kg/min。静脉泵入时严格监测患者的血流动力学，逐步调整剂量至达到所需的血流动力学状态。

异丙肾上腺素

适应证：

主要用于治疗严重窦性心动过缓、窦房传导阻滞、窦性停搏和完全性房室传导阻滞。心源性休克，感染性休克，支气管哮喘急性发作；QT间期延长综合征伴扭转型室性心动过速，当本品治疗无效时则使用起搏器。

用法与用量：

静滴

以1～2 mg溶于5%葡萄糖液500 ml缓慢滴注，根据心律、心率酌情调整滴速，滴速每分钟0.02～0.1 μg/kg

静脉泵入安全可控

（kg）×0.03配置，1 ml/h为0.01 μg/ kg/min。

去甲肾上腺素

作用及用途：

具有肾上腺素α受体强烈激动作用，引起血管极度收缩，血压升高，冠状动脉血流增加；同时也激动β受体，使心肌收缩加强，心排血量增加，静注用于各种原因引起的休克。

用法与用量：

小剂量每分钟0.4 μg/kg时，β受体激动为主；用较大剂量时，以a受体激动为主。

一般采用静脉滴注，需注意外渗易发生局部组织坏死。

静脉给药后起效迅速，停止滴注后作用时效维持1～2 min。小剂量开始使用，以0.02～0.1 μg/kg/min速度滴注，按需要调节滴速，按体重（kg）乘以0.03或0.3的总去甲肾上腺素剂量配于50 ml液体中，以1 ml/h的速度滴注，其给药量即为0.01 μg/ kg/min或0.1 μg/ kg/min。

多巴胺注射液

为多巴胺受体激动药。具有兴奋肾上腺素α、β受体的作用，但对β2受体作用较弱；同时也作用于肾脏和肠系膜血管、冠状动脉的多巴胺受体。

为较理想的抗休克药物，适用于中毒性休克、心源性休克、出血性休克、中枢性休克等各种类型休克，心脏停搏时升压等，尤其适用于伴有肾功能不全、心排出量降低、周围血管阻力增加而已补足血容量的休克患者。

小剂量

小剂量静脉滴注（每分钟1～5 μg/kg或每分钟200 μg）时，多为β作用，心排出量增加、肾血流量增加（肾动脉和肾小球血管扩张）、尿量增加，临床上可见到明显的升血压效果，而心率增加不明显。

中等剂量

中等剂量静脉滴注（每分钟5～20 μg/kg或每分钟0.3～1 mg）时由于α受体兴奋的缘故，虽然血压仍可升高，但由于外周血管收缩及肾血管的收缩作用，使心脏后负荷明显增加，心率亦可增快（多巴胺的正性频率作用出现）或减慢（升压反射所致），尿量反而减少（肾脏的有效滤过率下降）。

大剂量

大剂量（每分钟1.5～3 mg）时，由于其较强的α作用，组织灌注并不好，此时应加用扩血管药物，如硝普钠等扩血管药，减轻心脏的前后负荷，改善组织的灌注状态。

一般情况下，如果多巴胺的用量已经达到或超过20 μg/kg/min时，应及时加用第二种正性肌力药如多巴酚丁胺、肾上腺素、异丙肾上腺素等。

配制和应用方法：

用微量输液泵进行输注，体重（kg）×3为多巴胺的总剂量，用NS或GS 稀释至50 ml后，用微量推注泵给药，1 ml/h即为1 μg/kg/min。

利多卡因

作用：

适用于心肌梗死、洋地黄中毒、锑剂中毒、外科手术等所致的室性期前收缩、室性心动过速和心室颤动。

用法与用量：

静脉注射1～1.5 mg/kg，一般用50～100 mg作首次负荷量静注2～3 min，必要时每5 min后重复静脉注射1～2次，但1小时之内的总量不得超过300 mg。一般治疗量2～4 mg/min，维持量1 mg/min。

静脉滴注配法

利多卡因500 mg＋5%GS 500 ml，ivgtt。

50 kg患者：50 ml/h＝1 mg/kg/h；
60 kg患者：60 ml/h＝1 mg/ kg/h；
70 kg患者：70 ml/h＝1 mg/ kg/h。

微量泵给药

0.9%NS 25 ml＋利多卡因500 mg配制成50 ml微量泵。

50 kg患者：5 ml/h＝1 mg/ kg/h；
60 kg患者：6 ml/h＝1 mg/ kg/h；
70 kg患者：7 ml/h＝1 mg/ kg/h。

胺碘酮

作用：

是多通道阻滞剂，可表现出Ⅰ～Ⅳ类所有抗心律失常药物的药理作用。有广泛的抗心律失常作用。

主要适应症：阵发性室上速，特别是伴预激综合征患者；快速房颤、房扑心室率控制；室性心动过速、室颤。

首选适应症：威胁生命的室速、室颤；心肌梗死后心律失常；心律失常伴心功能不全；房颤、房扑的转律和窦律维持。

室颤或无脉室速的抢救

在心肺复苏中，如2～3次电除颤和血管加压药物无效时，立即用胺碘酮300 mg静脉注射，以5%葡萄糖稀释，快速推注，然后再次除颤。

如仍无效可于10～15 min后重复追加胺碘酮150 mg。

静脉滴注维持量，在初始6 h以内以1 mg/min速度给药；随后18 h以0.5 mg/min速度给药，第一个24 h内用药总量（包括静脉首次注射、追加用量及维持用药）一般控制在2.0～2.2g以内；第二个24 h及以后的维持量根据心律失常发作情况酌情减量。

持续性室速

对于血流动力学稳定的持续性单形、多形性室速和未明确诊断的宽QRS心动过速，首剂静脉用药150 mg，用5%葡萄糖稀释后推注10 min，首剂用药10~15min后如仍不见转复可重复追加静脉150 mg再负荷，用法同前。

若使用了胺碘酮数次负荷后室速未能很快转复，应考虑电复律。此种持续室速有反复发作的可能，一般需要静脉维持用药，方法同前述室颤或无脉性室速。

用法与用量：

首剂：常规150 mg＋5%GS 20 ml，静推10 min给予负荷量，继而1 mg/min泵入，6h后可减至0.5 mg/min。

配法：450 mg＋5%GS 36 ml至45 ml泵入，6 ml/h＝1 mg/min，6 h后减至半量3 ml/h＝0.5 mg/min，或600 mg＋5%GS 38 ml至50 ml泵入，5 ml/h＝1 mg/min，6 h后减至半量2.5 ml/h＝0.5 mg/min。

硝酸甘油

适应证：

用于冠心病心绞痛的治疗及预防，也可用于降低血压或治疗充血性心力衰竭。

用法用量：

用5％葡萄糖注射液或氯化钠注射液稀释后静脉滴注，5%GS 250 ml＋硝酸甘油10 mg，开始剂量为5 μg/min，根据血压调速。

最好用输液泵恒速输入，5%GS 44 ml＋硝酸甘油30 mg配成50 ml微量泵，1 ml/h＝10 μg/min，用量为10～200 μg/min，应根据个体的血压、心率和其他血流动力学参数来调整用量。

硝普钠

作用于动、静脉的速效短时强扩张剂，给药后即刻达峰，停药后仅维持1～10 min。适用用高血压急症，尤其适用于合并肺水肿的急性左心衰，难治性心衰伴高血压危象等情况。

用法与用量：

1～3 μg/ kg/min，从0.5 μg/ kg/min起始，每隔5～10 min增加0.5～1 μg，极量为10 μg/kg/min，直到达到满意的血流动力学效果。

配制方法：

50 mg＋5%GS 45 ml配成50 ml微量泵，避光应用。

50 kg患者：1.5 ml/h＝0.5 μg/ kg/min;
60 kg患者：1.8 ml/h＝0.5 μg/ kg/min;
70 kg患者：2.1 ml/h＝0.5 μg/ kg/min，一般应用不要超过72小时。

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2022-02-10 江雨波

太实用了，赶紧收藏

73 0
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2021-12-31 ms8000000342134097

学习

72 0
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2021-12-31 华医-Dr.Yang

学习

81 0
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2021-12-30 jiaoxuechu2255

不错👍

78 0
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2021-12-29 时期

学习

97 0
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2021-12-28 slli

好

86 0
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2021-12-28 wenzhiren

#心血管急救#

73 0
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2021-12-28 ms6000000487809205

学习了

0 0
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2021-12-28 小余97

棒啊

69 0
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2021-12-27 ms5000000350028237

受益匪浅！

64 0

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