简介:1、病历摘要患者林某,女,80岁,因突发胸痛3天,晕厥1次住院。否认“高血压病、糖尿病”史。查体P26次/分,BP105/60mmHg。心率26次/分,律齐,心音低钝,无杂音;肺、腹未见异常,双下肢无水肿。心电图III°方式传导阻滞,心室率26次/分。BNP632pg/ml,生化CO25.64mmol/l,AST518u/l,LDH907U/L,CK1130U/L,CKMB167U/L,GLU27.24mmol/l,BUN31.9mmol/l,CREA209umol/l,肌钙蛋白阳性。血常规WBC13.87*109/lNE82.6%。尿常规尿糖4+、酮体2+。诊断为1、冠状动脉粥样硬化性心脏病、AMI、KILLIP4级III°AVB2、2型糖尿病DKA3、肾功能不全。因有溶栓禁忌症,未行溶栓治疗。家属拒绝转院行起搏器治疗。入院后予以双联抗血小板聚集,抗凝,调脂稳定斑块,予以异丙肾上腺素8ug/min微量泵入、阿托品、地塞米松等处理,患者心室率波动于60-80次/分,并予以碳酸氢钠纠正酸中毒,胰岛素控制血糖等处理。随着心室率的增快逐渐减慢异丙肾上腺素的泵速,7天后复查ECG窦性心律,频发室早。
简介:摘要目的观察营心通脉方治疗冠心病合并房室传导阻滞的疗效。方法选取60例冠心病合并房室传导阻滞患者随机分为两组,治疗组30例,采用营心通脉方水煎服,每日2次,每次100mL;对照组30例,采用舒喘灵片0.4mg,每4小时1次口服,4周为1个疗程。共观察1个疗程。分别观察两组治疗前后中医证候积分及心电图等变化。结果治疗组心电图疗效显效率为36.67%,总有效率为90.00%;对照组显效率为26.67%,总有效率为73.33%。治疗组中医证候显效率为43.33%,总有效率为86.67%,对照组中医证候显效率为23.33%,总有效率为73.00%;经Ridit分析,两组疗效差异具有统计学意义(P<0.05)。观察期间治疗组及对照组均未见不良反应,提示两种策略均具有良好的安全性。结论营心通脉方治疗冠心病合并房室传导阻滞患者有较好的疗效和安全性,值得临床应用。
简介:心房纤颤(即下文中简称房颤)时常有长R-R间期和/或结(室)性逸搏出现,国内许多心电图专著依此而提出房颤伴Ⅱ°房室传导阻滞(Ⅱ°AVB)的各种心电图诊断标准。在临床实践中,我们觉得此类诊断标准的应用价值尚待论证。为此,我们收集了在24hHolter检查中具有2s以上R-R间期的房颤病例,进行动态心电图中心室率、长R-R间期及逸搏等诸项参数的分析研究。
简介: 摘要:目的 探讨对老年急性心肌梗死合并房室传导阻滞患者的临床护理及抢救。方法 对 80例急性心肌梗死患者中 20例合并房室传导阻滞的患者进行药物和临时或永久起搏器的安置,探讨心电监护、用药护理、电极脱落的预防、消化道及呼吸道护理、感染的预防和心理护理等。结果 20例 AMI合并 AVB患者入院后有 8例患者给予了异丙肾上腺素或阿托品短时间治疗, 4转为 II度 I型, 2例转为 I度 AVB, 2例转为窦性心律。其余 12例患者中 9例发生 Adams-Stokes综合征, 3例药物治疗无效,均行急诊手术安置临时心脏起搏器,术后 8例患者 7d内回复至窦性心律,遂撤除起搏器, 4例在 10d内尚未恢复者植入永久性人工埋藏式心脏起搏器。所有患者均抢救成功。结论 做好老年急性心肌梗死合并房室传导阻滞患者的临床及手术护理能够提高抢救率,是急性心肌梗死患者抢救成功的关键。 关键词:急性心肌梗死;房室传导阻滞;护理;老年患者 Abstract: Objective To explore the clinical nursing and rescue of elderly patients with acute myocardial infarction and atrioventricular block. Methods 20 patients with atrioventricular block in 80 patients with acute myocardial infarction were placed with drugs and temporary or permanent pacemakers. The ECG monitoring, medication nursing, prevention of electrode falling off, nursing of digestive tract and respiratory tract, prevention of infection and psychological nursing were discussed. Results 8 of 20 AMI patients with AVB were treated with isoproterenol or atropine for a short time after admission. 4 patients were converted to grade II type I, 2 patients to grade I AVB, and 2 patients to sinus rhythm. Among the other 12 patients, 9 developed Adams Stokes syndrome, 3 were ineffective in drug treatment, all of them received emergency operation and temporary cardiac pacemaker, 8 patients recovered to sinus rhythm within 7 days after operation, then pacemaker was removed, and 4 patients who had not recovered within 10 days were implanted with permanent implantable cardiac pacemaker. All patients were rescued successfully. Conclusion good clinical and operative nursing of elderly patients with acute myocardial infarction and atrioventricular block can improve the rescue rate, which is the key to the successful rescue of patients with acute myocardial infarction.