论文部分内容阅读
多巴酚丁胺加快房颤时的房室传导从而导致心功恶化鲜有报道。笔者遇到3例多巴酚丁胺显著增加房室传导,致特快型房颤(房颤室律≥180次/分)引起肺水肿,现报告如下。例1 女,40岁,因劳累后心悸,气紧8年,加重3个月入院。体检:患者呈半卧位,呼吸急促,双肺底少许水泡音。BP15/11kPa,P110±次/分,心律绝对不齐,心尖区闻及舒张期隆隆样杂音。EKG:房颤,心室率110±次/分;UCG:二尖瓣狭窄并轻度关闭不全,左室不大,左房45mm。诊断:风湿性心脏病,二尖瓣狭窄并关闭不全,心功能Ⅱ级。入院后用多巴酚丁胺40mg加入10％葡萄糖200ml以0.2mg/分速度静脉滴注,至60分钟时心悸加重,心率达130次/分,未予重视。2小时后出现端坐呼吸,双肺中、下部闻及中等量水泡音,特快房颤,室率达190次/分,遂停用多巴酚丁胺,加用西地兰、速尿、地塞米松静注等治疗后缓解。后再未用多巴酚丁胺也未复发。
Dobutamine atrial fibrillation to speed up the atrioventricular conduction resulting in heart failure rarely reported. The author encountered 3 cases of dobutamine significantly increased atrioventricular conduction, causing atrial fibrillation (atrial fibrillation ventricular ≥ 180 beats / min) cause pulmonary edema, are as follows. Example 1 Female, 40 years old, due to fatigue after heart palpitations, tight gas 8 years, increased 3 months admitted to hospital. Physical examination: The patient was in a semi-recumbent position with shortness of breath and a little blisters on both lungs. BP15 / 11kPa, P110 ± beats / min, the heart rhythm is absolutely absent, apex area smell and diastolic rumbling like noise. EKG: atrial fibrillation, ventricular rate 110 ± times / min; UCG: mitral stenosis and mild incomplete closure, left ventricular is not large, left atrium 45mm. Diagnosis: rheumatic heart disease, mitral stenosis and insufficiency, heart function Ⅱ level. After admission with dobutamine 40mg add 10% glucose 200ml to 0.2mg / min speed intravenous infusion, to 60 minutes, palpitations increased heart rate up to 130 beats / min, not valued. 2 hours after the onset of sitting breathing, the middle and lower lungs smell a moderate amount of blisters sound, express atrial fibrillation, room rate of 190 beats / min, then disable dobutamine, add cedilanate, furosemide, Dexamethasone intravenous and other treatment to ease. After no use of dobutamine also did not relapse.