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女患,64岁。主因晕厥,抽搐20分钟入院,于入院前20分钟休息时突然出现晕厥,抽搐,当地给予心前区叩击后神志转清,抽搐停止,既往有冠心病史5年,查体:P:70次/分,R18次/分,BP:16/10KPa,神志清,五官正常,双肺呼吸音清,心界不大,心率:70次/分,律齐,心音低钝未闻及杂音,腹部及四肢无异常,心电图示窦性心律;心肌缺血;完全性右束支传导阻滞,诊为冠心病,心源性晕厥。入院后给予心电监护,静点硝酸甘油等治疗,半小时后频繁出现晕厥,抽搐,心电监护示尖端扭转室速(Tdp),先后给予心前区叩击,利多卡因静推,及异丙肾上腺静点均无效,改为25%硫酸镁10ml静推,5分钟后发作终止,之后25%硫酸镁20ml加10%葡萄糖500ml,维持静点,未再发作。讨论:尖端扭转室速常发生于心脏传导阻滞,心
Female, 64 years old. Mainly because of syncope, convulsions admitted 20 minutes 20 minutes before admission when a sudden onset of syncope, convulsions, the local area to give precautions percussion clear, convulsions stopped, previous history of coronary heart disease for 5 years, physical examination: P: 70 Times / min, R18 beats / min, BP: 16 / 10KPa, clear mind, facial features normal, lung breath sounds clear, heart, heart rate: 70 beats / Abdominal and limbs were normal, ECG showed sinus rhythm; myocardial ischemia; complete right bundle branch block, diagnosed as coronary heart disease, cardiogenic syncope. After admission, the patients were given ECG monitoring and intravenous nitroglycerin treatment. Syncope, convulsions and ECG were performed after half an hour. Torsades de pointes (Tdp) Isoproterenol intravenous static points were invalid, changed to 25% magnesium sulfate 10ml static push, 5 minutes after the onset of seizures, followed by 25% magnesium sulfate 20ml plus 10% glucose 500ml, to maintain the static point, no further attacks. Discussion: Torsion-ventricular tachycardia often occurs in heart block