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1 临床资料患者,男性,81岁,本处离休干部。在营院内散步时发生心前区压榨性疼痛,含服硝酸甘油不缓解,大汗淋漓伴濒死感,由他人呼叫我门诊部急救医护人员到达。在检测心电图中患者意识丧失,出现抽搐、发绀、叹息样呼吸,血压为0。心电图示各导联 QRS 波群消失,代之以大小不等、宽大畸形的锯齿状颤动波。立即进行心前区捶击、持续心脏按压。抬入我门诊部抢救室后,建立静脉液路,肾上腺素1 mg稀释后弹丸式注射,3～5 min 一次。以30:2的心脏按压与人工呼吸次数比例行人工呼吸。室颤发生后4 min 内给予第1次200 J 非同步单相波形电击除颤,心律未转复。再次200 J 除颤后病人发出呻吟声,恢复自主呼吸,血压110/70 mm Hg,已能触及股动脉搏动。心电图示室上性节律,伴有频发室性期前收缩、短阵室性心动过速。ST_(v_1～v_5)
1 clinical data patients, male, 81 years old, the Department retired cadres. During the walk in the camp, there was exacerbated exacerbations of pain, nitroglycerin does not ease the service, sweating with sense of nearness, others call my clinic emergency medical staff arrived. Patients in the detection of ECG loss of consciousness, convulsions, cyanosis, sigh-like breathing, blood pressure is zero. QRS wave ECG lead disappeared group, instead of ranging in size, large deformity jagged quiver wave. Immediately pumped heart area, sustained heart pressure. Into my clinic emergency room, the establishment of venous fluid, 1 mg of epinephrine bolus injection, 3 ~ 5 min time. With 30: 2 heart pressure and artificial respiration ratio of the number of artificial respiration. The first 200 J of unsynchronized single-phase waveform defibrillation was given within 4 min of VF and the heart rate was not reversed. Once again, the patient molested after 200 J defibrillation, regained spontaneous breathing, and blood pressure was 110/70 mm Hg, which had reached the femoral artery pulsation. ECG showed supraventricular rhythm, with frequent ventricular contraction, paroxysmal ventricular tachycardia. ST_ (v_1 ~ v_5)