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患者,女,55岁。因咳嗽咳痰伴心悸3天,于1998年2月24日入院。原有冠心病、高血压病Ⅲ期4年。查体:T36.6℃,P90次/min,BP17/10kPa,颈静脉怒张,双肺呼吸音增粗,无罗音,心界明显扩大。HR118次/min,呈房颤律,无杂音,腹阴性,双下肢轻度凹陷性水肿。心电图示快室率房颤,ST-T改变。诊断为:①急性支气管炎;②冠心病,全心扩大,快室率房颤,心衰Ⅲ°。入院后给予罗氏芬、可乐必妥抗炎,西地兰、氨力农强心,双氢克尿噻利尿等综合治疗,支气管炎症及心衰均好转。入院后第8天在原治疗基础上加用心先安(徐州生物化学制药厂,批号:971101)120mg加入5％GS 250ml静滴qd,应用3d后出现失眠,难以入睡,即停用此药,停药后失眠逐渐好转,第4天失眠完全消失。
Patient, female, 55 years old. Due to cough and phlegm with heart palpitations 3 days, on February 24, 1998 admission. The original coronary heart disease, hypertension, stage 4 4 years. Examination: T36.6 ℃, P90 times / min, BP17 / 10kPa, jugular vein engorgement, lung breath sounds thick, no rales, heart significantly expanded. HR118 times / min, was atrial fibrillation law, no noise, abdominal negative, mild depression of both lower extremity edema. ECG rapid chamber rate of atrial fibrillation, ST-T changes. Diagnosis: ① acute bronchitis; ② coronary heart disease, whole-hearted enlargement, fasting rate of atrial fibrillation, heart failure Ⅲ °. After admission to give Roche Finn, Colabuterol anti-inflammatory, cedilanid, amrinone heart, hydrochlorothiazide and other comprehensive treatment, bronchial inflammation and heart failure are improved. On the 8th day after admission, add Xin Xian (Xuzhou Biochemical Pharmaceutical Factory, batch number: 971101) on the basis of the original treatment and add 250mg of 5% GS 250ml intravenously qd. After 3 days of application, insomnia will occur and it is difficult to fall asleep Insomnia gradually improved after medication, the first 4 days of insomnia disappeared completely.