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1病例报告患者男,57岁。因胸痛、胸闷4h入院。诊断为急性下壁心肌梗死,给予溶栓治疗。溶栓前心率58/min,嚼服拜阿司匹林300mg,口服氯吡格雷300mg,皮下注射低分子肝素5 000U,同时给予吸氧、盐酸哌替啶注射液25mg肌内注射等对症治疗。溶栓治疗40min后发生严重心动过缓,心率27/min,给予硫酸阿托品1mg注射,心率恢复至42~52/min,心电图Ⅱ、Ⅲ、aVF导联ST段回落,T波倒置;又出现心动过缓,心率33/min,同样给予硫酸阿托品1mg注射,心率恢复至72/min,再次出现Ⅱ、Ⅲ、aVF导联ST段抬高,较入院时明显;8min后,心电图Ⅱ、Ⅲ、aVF导联ST段再次回落,T波倒置;10min后Ⅱ、Ⅲ、aVF导联ST段又抬高。非手术治疗7天后出院,建议择期行冠状动脉介入手术治疗。
A case report male patient, 57 years old. Due to chest pain, chest tightness 4h admission. Diagnosis of acute inferior myocardial infarction, given thrombolytic therapy. Thrombolysis before the heart rate 58 / min, chewing served as aspirin 300mg, oral clopidogrel 300mg, subcutaneous low molecular weight heparin 5 000U, while giving oxygen, 25mg intramuscular injection of pethidine hydrochloride injection and other symptomatic treatment. Thrombolytic therapy after 40min severe heart bradycardia, heart rate 27 / min, given atropine sulfate 1mg injection, heart rate returned to 42 ~ 52 / min, ECG Ⅱ, Ⅲ, aVF lead ST segment down, T wave inversion; Too slow, heart rate 33 / min, also given 1mg atropine sulfate injection, the heart rate returned to 72 / min, again appeared ST segment elevation of lead Ⅱ, Ⅲ, aVF, compared with admission obvious; 8min, ECG Ⅱ, Ⅲ, aVF Lead ST segment down again, T wave inversion; 10min after Ⅱ, Ⅲ, aVF lead ST segment and elevated. Non-surgical treatment of 7 days after discharge, it is recommended elective coronary intervention.