论文部分内容阅读
患者聂××,男,54岁。因心肌病、心力衰竭、多发性室性早搏,1981年曾住院两次。1983年1月30日因心衰加重住院。入院后经强心、利尿、减轻心脏负荷等综合治疗,心衰症状改善。2月4日心电图示心房纤颤,室率100次/分,双束支阻滞(完全右束支传导阻滞+电轴右偏),多发多源性室性早搏,QT间期0.40秒,遂加用乙胺碘呋酮600mg/日分三次口服,症状逐日减轻。2月10日心电图示窦性心律,心率73次/分,室内三束支阻滞(完全右束支阻滞+电轴右偏+P-R间期0.28秒),QT间期0.25秒,血钾4.2毫克当量/升,即停乙胺碘呋酮。但患者担心心房纤颤复发,暗中继续服药,剂量未减。2月12日16时突感胸闷、气急,继而昏迷抽搐,瞳孔散大,尿失禁,呼吸心跳停止。当即拳击
Nie × × patients, male, 54 years old. Due to cardiomyopathy, heart failure, multiple premature ventricular contractions, hospitalized twice in 1981. January 30, 1983 hospitalized due to worsening heart failure. After admission by cardiac, diuretic, reduce heart load and other comprehensive treatment, heart failure symptoms improved. February 4 ECG showed atrial fibrillation, room rate 100 beats / min, double bundle branch block (complete right bundle branch block + right axis deviation), multiple premature ventricular contractions, QT interval 0.40 seconds , Then add amiodarone 600mg / day orally three times a day, reduce the symptoms day by day. February 10 ECG showed sinus rhythm, heart rate 73 beats / min, indoor three-bundle branch block (complete right bundle branch block + axis right deviation + PR interval 0.28 seconds), QT interval of 0.25 seconds, serum potassium 4.2 milliequivalents / liter, that is, stop amiodarone. However, patients worried about recurrence of atrial fibrillation, secretly continue to take medicine, the dose was not reduced. At 12 o’clock on the February 12 suddenly felt chest tightness, shortness of breath, and then coma convulsions, mydriasis, urinary incontinence, respiratory arrest. Immediate boxing