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1 病历资料患者,男性,38岁。以排尿时一过性意识丧失伴持续性心悸、气促4h为主诉于1989年3月1日入院。患者1980年心电图检查示预激综合征(A型)。自觉无不适。入院当天中午午睡时感尿憋厉害,急起床小便,排尿中突发一过性意识丧失,晕倒在地,10s后清醒,感持续性心悸、气促,无心前区疼痛,送单位医疗所,心电图示频速型房颤,经处理无效转我院。1985,1986年曾两次因憋尿厉害后出现排尿性晕厥,快速型心律失常。查体:P168,R24,BP16/8.0kPa。急性重病容,颜面皮肤擦伤。颈软,颈静脉稍充盈。胸廓对称,心界不大。HR180,s_1稍减弱,心律绝对不齐,强弱不等,无病理性心脏杂音。双肺(一)。腹平软,肝脾肋下未触及。双下肢无凹陷性浮肿,双膝反射存在,双侧巴彬斯基氏征(一)。入院后拟诊排尿性晕厥,预激综合征并频速型房颤。在心电监护下,静脉给普鲁卡因酰胺,口服乙
Patient information, male, 38 years old. To urinate transient loss of consciousness with persistent heart palpitations, shortness of breath 4h-based complaint was admitted on March 1, 1989. Patients with electrocardiogram in 1980 showed pre-excitation syndrome (A type). Consciously all right. Noon on the day of admission, nausea, urinary urgency, acute urination, urination burst in a sudden loss of consciousness, fainted to the ground, awake after 10s, persistent heart palpitations, shortness of breath, no pain in front of the heart, sent to the unit of medical , Electrocardiogram frequency of atrial fibrillation, invalid treatment transferred to our hospital. 1985, 1986, twice because of holding urine out after urinary syncope, tachyarrhythmia. Physical examination: P168, R24, BP16 / 8.0kPa. Acute serious illness, facial skin abrasions. Neck soft, slightly filling the jugular vein. Thorax symmetry, the heart is not big. HR180, s_1 slightly weakened, the heart rhythm is absolutely missing, the strength of the range, no pathological heart murmur. Double lungs (a). Abdomen soft, liver and spleen ribs untouched. No lower eyelid edema, knee reflex exists, bilateral Babinski’s sign (a). After admission diagnosed with diarrhea syncope, Wolff-Parkinson’s syndrome and frequent atrial fibrillation. Under ECG monitoring, intravenous procainamide, oral B