论文部分内容阅读
例1、女性,34岁。主因气短、发憋加重5天,于1991年1月9日入院。既往有风湿性心脏病史5年。查体:BP16/10.5kkPa,急性面容,面色潮红,口唇紫绀,双肺可闻少许湿罗音,心律不整,心尖部可闻双期杂音,腹软,无压痛,肝脾未触及,双下肢无浮肿。心电图示阵发性室速,心房纤颤。往院诊断:风湿性心脏病,二尖瓣狭窄及关闭不全,阵发性室速及心房纤颤,肺部感染。给强心、利尿、抗感染及利多卡因100mg静脉缓推,并同时以2mg/分静滴,持续24小时后,室速时有发生,又静推利多卡因100mg,约2分钟后,病人烦燥、辗转不安,四肢乱动,被迫坐起,继之呼吸停止,立即肌注苯巴比妥钠0.1,数分钟后呼吸正常。将利多卡因减慢1mg/分维持12小时,室速消失,停用此药,改口服慢心律,未再发生呼吸抑制,往院2周,病情稳定出院。 例2、男性,78岁。主因阵发性心悸,气短2周,于1994年11月6日往院。查体:BP16/10.5kPa,神清,体质消瘦,双肺散在干湿罗音,心率98次/分,每分钟可闻3次早搏,心音有力,各瓣膜未闻杂音。心电图示:偶发室早,心肌缺血。往院诊断:冠心病,偶
Example 1, female, 34 years old. Mainly because of shortness of breath, hair Biezeng increase 5 days, January 9, 1991 admission. Previous history of rheumatic heart disease 5 years. Physical examination: BP16 / 10.5kkPa, acute face, flushed, cyanotic lips, lungs can smell a little wet rales, irregular heartbeats, apex can be heard two-phase murmur, abdominal soft, no tenderness, liver and spleen not touched, both lower extremities No swelling. ECG showed paroxysmal VT, atrial fibrillation. To the hospital diagnosis: rheumatic heart disease, mitral stenosis and insufficiency, paroxysmal ventricular tachycardia and atrial fibrillation, pulmonary infection. To cardiac, diuretic, anti-infection and lidocaine 100mg slow intravenous and intravenous infusion at the same time to 2mg / min, sustained 24 hours after VT occurs, and intravenous lidocaine 100mg, about 2 minutes later, Patients were irritable, twitchy, limbs were disturbed, forced to sit up, followed by respiratory arrest, immediately intramuscular injection of sodium phenobarbital 0.1, breathing normally after a few minutes. The lidocaine slowed 1mg / min for 12 hours, ventricular tachycardia disappeared, disable the drug, change oral slow heart rate, respiratory depression did not occur again, to hospital for 2 weeks, the disease was stable and discharged. Example 2, male, 78 years old. Mainly due to paroxysmal palpitations, shortness of breath for 2 weeks, on November 6, 1994 to the hospital. Physical examination: BP16 / 10.5kPa, Shen Qing, weight loss, lungs scattered in the wet and dry rales, heart rate 98 beats / min, 3 beats per minute premature beats, strong heart sounds, the valve unobstructed noise. ECG shows: Sporadic room early, myocardial ischemia. To the hospital diagnosis: coronary heart disease, even