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病人女性,80岁,体重50kg,因绞窄性疝伴肠梗阻拟行急症手术。既往无缺血性心脏病或充血性心衰症状,但有功能性三尖瓣关闭不全。血压170/90mmHg,心律规则,心率70次/分。实验室常规检查均正常。胸部X线示左上胸壁有起搏器发生器,导线完整,尖端位于右室顶部。入院时ECG示起搏器功能良好,可由自主室跳抑制。入手术室后持续监测ECG和血压,起搏器功能良好,血压稳定。预先吸氧omin后,麻醉诱导用硫喷妥钠125mg,芬太尼0.05mg,琥珀胆碱50mg,并行环状软骨压迫。气管插管期间,ECG临测仪QRS瞥报声消失,心跳停止,无起搏器波形,颈动脉搏动未触及。开始胸外心脏按压,纯氧通气,ECG示室颤,用直流电(50-J)除颤,恢复特发性室性心律(35次/分),收缩压90mmHg。第二次发生室颤时再次予以除颤,维持缓慢特发性室性心律。滴
Female patient, 80 years old, weighing 50kg, due to strangulated hernia with intestinal obstruction intended for emergency surgery. No previous ischemic heart disease or congestive heart failure, but functional tricuspid regurgitation. Blood pressure 170 / 90mmHg, heart rate rules, heart rate 70 beats / min. Laboratory routine tests are normal. Chest X ray showed a left upper chest wall pacemaker generator, complete wire, the tip is located at the top of the right ventricle. The ECG shows a good pacemaker on admission and can be suppressed by an independent room hop. Continued monitoring of ECG and blood pressure after operating room, pacemaker function well, blood pressure stability. After pre-oxygen inhalation omin, induction of anesthesia with thiopental 125mg, fentanyl 0.05mg, succinylcholine 50mg, parallel to the cricoid pressure. During endotracheal intubation, QRS glances disappeared, the heartbeat stopped, the pacemaker waveform was absent, and the pulse of the carotid artery was not touched. Thoracic cardiac compression, pure oxygen ventilation, ECG VF, defibrillation with DC (50-J), recovery of idiopathic ventricular arrhythmias (35 beats / min) and systolic blood pressure 90 mmHg were started. The second occurrence of ventricular fibrillation defibrillation again to maintain a slow idiopathic ventricular rhythm. drop