倍它洛克与异搏定同用致阿斯综合征一例天津市民族医院（３００１２２）张令生患者女，６０岁，主因出现心悸伴胸闷憋气一年，入院前一天上述症状加重。心电图示窦性心律，频发房性早搏，收入院诊洽。住院后即给予β——受体阻滞剂一倍它洛克２５ｍｇ，３／日，加用镇静剂治疗房性心律失常。然在此治疗期间房性早搏未见明显减少。在住院第五天时出现阵发心房纤颤，给予西地兰０．２ｍｇ静脉推注，半小时后转为窦性心律。在住院二十天时，由于房性早搏未能很好控制，在没停用倍它乐克同时给予异搏定４０ｍｇ口服，翌日午后７：３０分（至此异博定总量仅用１６０ｍｇ），患者突然述头晕心悸、胸闷，即刻神志丧失，四肢抽搐、小便失禁，２～３分钟后神志转清，当时查体：Ｂｐ０，面色苍白，四肢厥冷，脉搏细弱，心率１５～２０次／分，心音低钝，双肺呼吸音清晰，急查ＥＣＧ示：窦性停搏，交界性逸搏心律，室率２０次／分，律齐（Ｒ－Ｒ间距３″），即刻给予阿托品０．５ｍｇ静脉推注，同时给予异丙肾０．４ｍｇ加５％葡萄糖２００ｍｌ中，静脉点滴２０～４０滴／分，根据心率情况调节滴数。１５分钟后Ｒ－Ｒ间距缩短为１．４″，二次给予阿托品０．５ｍｇ静脉推注，１０分钟后仍示交界区逸搏心律，室率增 Times it Locke and verapamil with Astragalus syndrome caused by a case of Tianjin National Hospital (300122) Zhang Lingsheng female patient, 60 years old, the main cause of palpitations with chest tightness, suffocation for one year, the day before admission the above symptoms worsened. ECG shows sinus rhythm, frequent atrial premature beats, income hospital consultation. After admission to give beta-blockers twice that it Locke 25mg, 3 / day, plus sedatives for the treatment of atrial arrhythmias. However, during this treatment, atrial premature beats no significant reduction. Paroxysmal atrial fibrillation occurred on the fifth day of hospitalization, given cedilanid 0.2mg intravenous injection, half an hour later converted to sinus rhythm. Twenty days of hospitalization, due to premature atrial premature beats are not well controlled, did not stop times of music at the same time given verapamil 40mg orally, 7:30 the next afternoon (so far the total amount of different Bo Ding 160mg) Patients suddenly described dizzy heart palpitations, chest tightness, immediate loss of consciousness, limbs twitch, urinary incontinence, 2 to 3 minutes after consciousness clear, then physical examination: Bp0, pale, limbs and cold, weak pulse, heart rate 15 to 20 beats / min , Low heart sound dull, clear lung breath sounds, acute ECG showed: sinus arrest, borderline escape rhythm, room rate 20 beats / min, law Qi (R-R spacing 3 “), immediately given atropine 0. 5mg intravenous injection, while given isoproterenol 0.4mg plus 5% glucose 200ml, intravenous drip 20 to 40 drops / min, according to the adjustment of heart rate drip number .15 minutes after the R-R spacing shortened to 1.4 ” Secondary administration of atropine 0.5mg intravenous injection, after 10 minutes still showed junction zone escape rhythm, ventricular rate increased