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患者王××,男,63岁,因持续性胸骨后绞痛于1994年11月14日9点15分急诊来院。待诊中突然晕厥抽搐,呼吸、心跳骤停。当班医务人员立即心肺徒手复苏,头带冰帽,吸氧,心电监测,并给肌注肾上腺素2mg。此时显示为心室纤颤,立即给300焦耳/秒电击除颤,没有成功。于是静脉再给肾上腺素1.0mg,可拉明、洛贝林各2支,再次以300焦耳/秒,电击一次。心电示波为室性自搏心律,自主呼吸恢复。此时除继续心脏按压外,静脉给利多卡因200mg,阿托品2.0mg,肾上腺素1.0mg;同时在第一静脉通路中以2～4mg/分速度静点利多卡因(500ml液体中含利多卡因500mg),另一条通路快速静点25％甘露醇250ml,5％碳酸氢纳250ml。此时心电再次显示室颤,病人口吐白色泡沫痰,听诊肺部湿罗音亦增多,于是静脉给地塞米松10mg,速尿40mg,继续心脏按压,并又相继2次以300焦耳/秒非同步电击除颤。此后心电显示为室速,继续心脏按压,静脉推注利多卡因100mg,静点硝酸甘油10mg,多巴胺60mg。至11点15分持续室速,静脉再次推利多卡因100mg,接点极化液,11点25分再次推注利多卡因100mg,安定10mg,快速静点甘露醇250ml。12点,心电:恢复窦性心律,偶发室性早搏,广泛前壁、高侧壁心肌梗塞。急检心肌酶CK5955u/L,GOT603u/L,
Patient Wang × ×, male, 63 years old, was hospitalized at 9:15 on November 14, 1994 due to persistent sternal colic. Tentative sudden syncope convulsions, breathing, cardiac arrest. On-duty medical staff immediately resuscitation of heart and lungs, headband ice cap, oxygen, ECG monitoring, and intramuscular injection of adrenaline 2mg. This time, ventricular fibrillation appears, immediately to 300 joules / second electric shock defibrillation, no success. The vein was given epinephrine 1.0mg, Cocaine, 2 capsules of Lobeline, once again at 300 joules / second. ECG wave of ventricular stroke self-paced, spontaneous breathing recovery. At this point in addition to continuing heart pressure, the intravenous lidocaine 200mg, atropine 2.0mg, epinephrine 1.0mg; at the same time in the first venous access to 2 ~ 4mg / min speed point lidocaine (500ml liquid containing lidocaine Due to 500mg), the other way fast static point 25% mannitol 250ml, 5% bicarbonate satisfied 250ml. At this point ECG once again shows ventricular fibrillation, the patient spit white foam sputum, auscultation lung wet rales also increased, so intravenous dexamethasone 10mg, furosemide 40mg, continue heart pressure, and then 2 times to 300 joules / Second asynchronous shock defibrillation. After the ECG showed ventricular tachycardia, continue heart pressure, intravenous lidocaine 100mg, intravenous nitroglycerin 10mg, dopamine 60mg. To 11:15 sustained ventricular tachycardia, venous again push lidocaine 100mg, contact polarized solution, 11:25 bolus lidocaine again 100mg, stability and 10mg, rapid intravenous injection of mannitol 250ml. 12 points, ECG: to restore sinus rhythm, premature ventricular premature beats, extensive anterior wall, high sidewall myocardial infarction. Urgent cardiac enzyme CK5955u / L, GOT603u / L,