心得安诱发洋地黄中毒致死一例吉县人民医院（０４２２００）李玉保，常晋华，逯德平患者女，５８岁。患风心病、二尖瓣狭窄２０余年，伴心房纤颤５年。１９８７年２月１０日因心衰加重入院。入院时患者呈端坐呼吸，口唇发绀，颈静脉怒张，双肺可闻及干、湿罗音，心界向两侧扩大，心律绝对不齐，心率平均１５０次／分，心尖部可闻及舒张期隆隆样杂音。肝大肋下３ｃｍ，肝颈反流征阳性，双下肢轻度水肿。入院诊断为风心病，二尖瓣狭窄、心衰Ⅱ°，心功能三级，心房纤颤。入院后给予强心，利尿、抗生素治疗。每日给静注西地兰０．４ｍｇ分两次。四天后患者一般情况好转，心衰基本控制，但心室率仍在１２０次／分以上，便加用心得安５ｍｇ，于当日上午１１时许服下，约半小时患者出现恶心、烦燥，值班医生考虑为一般的胃肠道反应，给肌注爱茂尔２ｍｌ，异丙嗪２５ｍｇ，症状无改善。于下午２时许，上述症状加重，并出现呼吸困难、双目上吊，急查心电图示窦缓，室性二联律，短阵室速，之后形成室颤死亡。讨论：由于心得安有严重的不良反应，故在选用时应严格掌握适应症，对心脏明显增大的患者，最好忌用，或者选用具有内源性拟交感作用的α受体阻滞剂如心得静，心得平等。其次由于心得安的个体剂量及口服血 An ambitious induced digitalis poisoning died of a case of Jixian People’s Hospital (042200) Li Yu-bao, Chang Jinhua, Qiu Deping patients female, 58 years old. Suffering from rheumatic heart disease, mitral stenosis more than 20 years, with atrial fibrillation for 5 years. February 10, 1987 due to worsening hospital admission. Patients were sitting on the hospital when breathing, cyanotic lips, jugular vein engorgement, the lungs can be heard and dry and wet rales, the heart to both sides of the expansion, the heart rate is absolutely missing, the average heart rate 150 beats / min, the apex can be heard And diastolic rumbling noise. 3cm liver ribs, liver reflux syndrome positive, mild lower extremity edema. Admission diagnosis of rheumatic heart disease, mitral stenosis, heart failure Ⅱ °, cardiac function, atrial fibrillation. Give cardiac, diuretic, antibiotic treatment after admission. Daily intravenous injection of cedilamine 0.4mg twice. Four days later, the general condition of the patient improved, heart failure basic control, but the ventricular rate was still 120 beats / min or more, then add the safety of 5mg, at 11 o’clock in the morning to take, about half an hour patients with nausea, irritability, duty Doctors consider the general gastrointestinal reaction, intramuscular injection of love Mau 2ml, promethazine 25mg, no improvement in symptoms. At 2 o’clock in the afternoon, the above symptoms increased, and breathing difficulties, hanging eyes, echocardiography sinus bradycardia, ventricular bicusses, paroxysmal ventricular tachycardia, after the formation of ventricular fibrillation death. Discussion: Since the experience of serious adverse reactions, so the selection should be strictly controlled indications, significantly increased heart patients, the best hanged, or the use of endogenous sympathetic effect of α-blockers If calm, equal experience. Second, due to the safety of the individual dose and oral blood