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近几年来,我们在治疗风湿性心瓣膜病心功能Ⅳ级(NYHA)的重度充血性心力衰竭的过程中,发现12例严重心动过缓,现报道如下.1 临床资料1.1 诊断标准①根据体检、X线胸部透视或胸片、心电图和超声心动图诊断为风湿性心瓣膜病.凡心室率低于50次/分为严重心动过缓.②根据NYHA分级标准诊断心功能Ⅳ级.临床上病人有严重的水钠潴留、容量过多、表现为端坐呼吸、颈静脉怒张、肺部湿罗音、肝大、腹水、骶部及双下肢水肿.1.2 一般资料 男4例,女8例,年龄 52～65岁.其中风湿性心脏病二尖瓣狭窄及关闭不全8例;主动脉瓣关闭不全1例;二尖瓣狭窄+主动脉瓣关闭不全3例.全部病例入院时的心律均为心房纤颤,心室率100～130次/分.1.3 治疗和观察方法①首选利尿剂:速尿40～
In recent years, we found 12 cases of severe bradycardia in the treatment of severe congestive heart failure with rheumatic valvular heart disease class Ⅳ (NYHA), are reported as follows.1 clinical data 1.1 diagnostic criteria ① based on physical examination , Chest X-ray or chest X-ray, electrocardiogram and echocardiography diagnosis of rheumatic valvular heart disease.Where the ventricular rate was lower than 50 / divided into severe bradycardia.② According to the NYHA classification criteria for the diagnosis of cardiac function grade Ⅳ. Clinically Patients with severe water and sodium retention, over capacity, manifested as sitting breathing, jugular vein engorgement, lung wet rales, liver, ascites, sacral and lower extremity edema .1.2 General information 4 males and 8 females Cases, aged 52 to 65 years of rheumatic heart disease in which mitral stenosis and insufficiency in 8 cases; aortic valve insufficiency in 1 case; mitral stenosis + aortic valve insufficiency in 3. All cases admitted to the heart rhythm Are atrial fibrillation, ventricular rate of 100 to 130 beats / min.1.3 treatment and observation methods ① preferred diuretic: furosemide 40 ~