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患儿男,11岁。因发烧、咳嗽3天,昏迷3h入院。心电图示窦性心动过速、心肌损害。临床诊断:病毒性脑炎并病毒性心肌炎。入院后11h突然测不到血压,心率180—200次/min,心音极低钝。即刻12导联心电图(附图)示窦性心动过速,P-R间期0.13s,R-R间期规整,心率150次/min,各导联出现ST-T交替现象,如aVL、aVF、V_2导联ST段抬高与正常(或基本正常)交替,在Ⅲ导联压低与抬高交替;在Ⅰ、Ⅱ、V_3—V_6导联中第1、3、5个QRS波群之后的ST-T显著压低,而Ⅰ、Ⅱ、V_3—V_6导联第2、4个QRS波群呈小r或呈直线样,继以显著抬高的ST-T类似急性损伤电流产生的单向曲线,致使上述波形呈不完全QRS波群而不易辨认。aVR、V_1导联QRS波群酷似室性心动过速,但本图为12导联心电图连续记录,Ⅱ、Ⅲ、aVF、V_2导联上的P波很清楚,故不难鉴别。心电图诊断:窦性心动过速、ST-T电交替。经用大量的激素及维生素C,配合其它急救措施,于2h50min后患儿病情逐渐好转,血压12/9kPa(90/65mmHg),心率140—150次/min,心音低钝。加用多巴酚酊胺后于入院48h神志清醒。入院72h心率稳定在80次/min左右。第3天复查心电图为窦性心律,不完全性干扰性房室脱
Children male, 11 years old. Due to fever, cough for 3 days, coma 3h admission. ECG shows sinus tachycardia, myocardial damage. Clinical diagnosis: viral encephalitis and viral myocarditis. 11h after admission can not be measured blood pressure, heart rate 180-200 times / min, low heart sound blunt. Immediate 12-lead electrocardiogram (with photos) shows sinus tachycardia, PR interval 0.13s, RR interval regular, heart rate 150 beats / min, ST-T alternating leads appear in the lead, such as aVL, aVF, V_2 guide The ST-segment elevation was normal to normal (or almost normal) alternation, and the lead was depressed and elevated alternately in lead III. ST-T after the 1,3,5 QRS complex in leads I, II and V_3-V_6 , While the QRS wave groups in the I, II and V_3-V_6 leads showed a small r or a straight line, followed by a unidirectional curve similar to the ST-T-like acute injury current significantly elevated, Waveform was incomplete QRS complex and not easy to identify. aVR, V_1 lead QRS complex resembles ventricular tachycardia, but this picture is a 12-lead electrocardiogram continuous recording, Ⅱ, Ⅲ, aVF, V 2 lead P wave is very clear, it is not difficult to identify. ECG diagnosis: sinus tachycardia, ST-T alternating electricity. With a large number of hormones and vitamin C, with other first aid measures, children in 2h50min condition gradually improved, blood pressure 12 / 9kPa (90 / 65mmHg), heart rate 140-150 beats / min, heart sound low blunt. Addition of dobutamine after 48h admission consciousness. Admission 72h heart rate stable at 80 beats / min or so. On the third day, the electrocardiogram was retrospectively analyzed as sinus rhythm, incompletely atrophic atrioventricular detachment