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患者女性,56岁,于1972年8月9日因突然发生严重的枕部头痛,随之半昏迷而住院。脑脊液检查呈血性。胸部及头颅平片正常。心电图改变符合急性中枢神经系统疾患(窦性节律,QT间期延长,对称性T波增宽)。逆行肱动脉造影证实从基底动脉顶端的分叉处有1厘米大的动脉瘤向前突出,侵及第三脑室底部。住院后因高血压(200/98毫米汞柱)于8月11日输注三甲硫吩(Trimethaphan),8月12日早晨开始静脉注射甲基多巴,血压下降到180/90毫米汞柱。下午3时在心电图监护器中首次观察到短阵的快速型室性心动过速,且其频率和持续时间迅即增加,并伴有血压下降(90/70毫米汞柱)和昏睡与神经错乱的加重。即采用了利多卡因多次静注及滴注,并曾采用苯妥因钠、普鲁卡因酰胺、地高辛、心得安、阿托品静注。上述这些治疗对心律紊乱并无效果。
A 56-year-old female patient, hospitalized on August 9, 1972 due to a sudden severe occipital headache followed by a semi-coma. Cerebrospinal fluid was bloody. Chest and skull plain film normal. ECG changes in line with acute central nervous system disorders (sinus rhythm, QT interval prolongation, symmetrical T wave broadening). Retrograde brachial artery angiography confirmed from the top of the basilar artery at the bifurcation 1 cm large aneurysm forward, penetrating the bottom of the third ventricle. Trimethoprim (Trimethaphan) was infused on August 11 due to high blood pressure (200/98 mm Hg) after hospitalization and methyldopa intravenously on the morning of August 12 and the blood pressure dropped to 180/90 mm Hg. A rapid burst of ventricular tachycardia was first observed in an ECG monitor at 3:00 PM with an immediate increase in frequency and duration accompanied by a drop in blood pressure (90/70 mmHg) and drowsiness and neurological disorders Increase. That is, lidocaine intravenous infusion and repeated intravenous infusion, and had used phenytoin sodium, procainamide, digoxin, propranolol, atropine intravenous injection. These treatments have no effect on heart rhythm disorders.