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1 临床资料 患儿男,2岁,因发作性脸色苍白、心悸8h入院。患儿既往体健,1月前曾有类似发作,用西地兰治疗,疗效不佳,1d后自行缓解。入院体检:发育营养中等,神萎,气急;心率230次/min,律绝对不齐,各瓣膜听诊区无器质性杂音,两肺呼吸音清,腹平软,肝脾触诊无异常,四肢脊柱活动自如,肢体末端无紫绀。实验室检查:ESR25mm/1 h,心肌酶谱正常,ASO<500U,血尿粪常规正常,胸部X线及心脏彩超均未见异常,EKG示房颤(心室率200次/min)。入院后给予西地兰,能量合剂,青霉素及其他对症支持治疗,3d内西地兰达饱和剂量,但症状仍反复发作,发作时EKG表现不一,呈阵发性极速性房颤,频发房早或频发交界性早搏伴短阵交界性心动过速,多次复查EKG于发作间歇期发
1 clinical data Children, 2 years old, due to the onset of pale, palpitations 8h admission. Children with previous physical health, had a similar attack in January, with cedilanized treatment, poor efficacy, 1d after self-remission. Admission medical examination: the development of nutritional medium, Shen Wei, shortness of breath; heart rate 230 beats / min, the law is absolutely missing Qi, the valve auscultation no organic murmur, lung breath sounds clear, abdominal soft, palpable no abnormalities, Extremities spine freely, no cyanosis at the extremities. Laboratory tests: ESR25mm / 1h, normal myocardial enzymes, ASO <500U, normal blood and urine excrement, chest X-ray and echocardiography were normal, EKG showed atrial fibrillation (ventricular rate 200 beats / min). After admission, cedilanid, combination of energy, penicillin and other symptomatic and supportive treatment were given, and the dose of cedilanid was saturated for 3 days. However, the symptoms were still recurrent. EKG showed different manifestations during the attack, showing paroxysmal atrial fibrillation Room early or frequent borderline premature beats with short array borderline tachycardia, repeated EKG in the onset of intermittent episodes