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患者男性,26岁,因饮酒后突发心前区疼痛1小时伴大汗淋漓于1990年8月18日急诊入院。查体:T36.5℃,P 210次/分,Bp15/11 kPa(112/82 mmHg)。神志清楚。双肺呼吸音清晰,心界不大,心率230次/分,律不齐,心音强弱不等。腹部无异常。心电图示:心室率250次/分,P波消失,QRS波宽大畸形,时限大于0.12秒,R-R间距绝对不等,最短间距0.20秒,考虑快速心房颤动(简称房颤)、室上性心动过速等。在心电监护下刺激迷走神经,按压颈动脉赛,先后给予静脉推注西地兰、异搏定、ATP、间羟胺均不奏效。半小时后试用利多卡因100mg静脉推注,20分钟后再次快速使用100mg静脉推注,心室率减慢至180次
Male patient, aged 26, was admitted to the emergency department on August 18, 1990 for 1 hour with an acute precordial pain after drinking. Examination: T36.5 ℃, P 210 beats / min, Bp15 / 11 kPa (112/82 mmHg). Consciousness. Breath sounds clear lungs, the heart is not big, heart rate 230 beats / min, irregular, heart sound intensity range. No abnormal abdomen. ECG: ventricular rate of 250 beats / min, P wave disappeared, QRS large wave deformity, time is greater than 0.12 seconds, RR interval is absolutely unequal, the shortest interval of 0.20 seconds, consider rapid atrial fibrillation (AF), supraventricular heartbeat Speed and so on. In the ECG to stimulate the vagus nerve, press the carotid artery race, has given IV cedilanid, verapamil, ATP, between the hydroxylamine are not working. Half an hour after the trial of lidocaine 100mg intravenous bolus, 20 minutes after the rapid use of 100mg intravenous bolus, ventricular rate slowed to 180 times