这些常见心律失常,病因没那么简单!

2017-10-04 奔跑的阿托品 医学界心血管频道

心律失常是心血管科的常见病,目前对于心律失常的诊断和治疗越来越规范,效果也越来越好。对于一些心律失常诊治过程中的特殊情况,或一些细节,值得我们思考与警惕

心律失常是心血管科的常见病,目前对于心律失常的诊断和治疗越来越规范,效果也越来越好。对于一些心律失常诊治过程中的特殊情况,或一些细节,值得我们思考与警惕,特此整理两例,供大家参考。

一、窦性心动过缓,原因并不简单

在心内科工作,经常会接到外科的术前会诊,有的是肌酶高,有的是心率快,有的是心电图ST-T改变,有的是心率慢。很多时候,病人心脏问题并不是很大,只是做一下术前评估。会诊的次数多了,科室的医生每次遇到这种情况,大多都觉得“没有挑战性”,可是,我遇到的一次会诊,却让大家对于会诊有了新的热情。

那是一天的上午,我正在办公室处理医嘱,护士将一张会诊单放到我的桌子上,“医生,外科会诊。”“我看看是什么情况。”

还没等我看会诊单,我旁边的进修医生将会诊单拿了起来,“老师,我觉得我都能会诊。”“哦?那你说说看。”

我说着看了看会诊单。“病人窦性心动过缓,做个阿托品实验,心率上来了就不用管,上不来就放临时起搏器。”进修医生说出了他的看法。

“对,你说的没错,我就让外科按照你的意思办。不过我还是要去看看,不然外科还得打电话叫我。”我说道。术前心率偏慢的病人,经常会遇到,处理方案也和那位进修医生说的差不多,但是医疗工作需要严谨,我还是亲自去看了看病人。在听完患者的主治医生和患者本人的描述后,我觉得这并不是一个简单的问题。

病史简介

患者,男,62岁,以“发作性上腹部疼痛5年,加重3天”为主诉入院。

患者5年前因饮食不洁出现上腹部疼痛不适,在外院诊断为“胆囊炎”,经住院治疗(具体不详)后病情好转出院,出院后间断口服“消炎利胆片”等药物,病情时有反复。

3天前少量饮酒后出现上腹部疼痛不适,以右侧为着,伴恶心,无呕吐,口苦,口干,偶有胸闷气短,无胸痛,无咳嗽、咳痰,头晕,无视物旋转,无头痛,全身乏力。入院前曾晕厥1次,数秒后自行清醒。

既往:“窦性心动过缓”病史5年,未做治疗。否认“高血压糖尿病”病史。

入院查体:体温36.8℃,脉搏46次/分,呼吸20次/分,血压120/76mmHg。双肺呼吸音粗,未闻及干湿性啰音,心率46次/分,律齐,心音可,各瓣膜听诊区未闻及病理性杂音。腹部压痛阳性,反跳痛弱阳性,墨菲氏征阳性。

入院诊断:1.慢性胆囊炎(急性发作);

2.窦性心动过缓。

看过患者的病历,有两个地方引起了我的注意:一是患者窦性心动过缓的病史和胆囊炎的病史,时间相差不多,这是不是巧合?两者之间有没有关系?

另一个是患者入院前曾晕厥过1次,什么原因造成的晕厥?会不会是心率慢引起的?带着疑问,我给病人查体,基本和病程里记录的相同,我重点听诊了心脏,心率44次/分!

“病人情况怎么样,最好能带个动态心电图。”我提出了我的看法。“病人目前病情有点棘手,胆囊可能化脓了,主任的意思是尽快手术。”病人的主治医生给出了回复。“那就放临起吧,你们的手术做完以后可以转我们科。”和外科商量后,我给出了会诊意见。

当天在安置好临时起搏器后,病人进行了胆囊切除术,术后转入了我科,术后第二天我听诊心脏,心率70次/分,令我惊奇的是,心电监护并不是起搏心率!请示主任后,主任要求再观察一天,如果还是这样,临时起搏器可以卸掉。那天刚好我值班,这个病人成为了我的关注对象,心率一直波动在70-86次/分之间,主任汇报后,把临时起搏器卸掉,病人的心率一直维持在70-90次/分之间,并且头晕,乏力的症状明显改善!

这时候,会诊时的两个疑问又浮现在了我的脑海,于是我大胆的猜想:病人的窦性心动过缓很可能是胆囊的原因引起来的!因为胆囊炎急性发作,使得心率比以往更慢,造成了病人的晕厥。胆囊切除后,病因解除了,心率也就恢复正常了。病人出院后,我专门随访了4个月,心率一直在正常范围,后来由于病人联系不上,随访也就中断了。

窦性心动过缓,心血管医生在临床上经常遇到,但是胆囊的原因造成的心率慢,临床上并不多见,也许很容易被忽略。探寻其中的机制,可能与胆囊炎使得迷走张力增高、自主神经功能紊乱,诱发心脏活动失调有关。我们在处理心律失常的时候,既要针对症状进行处理,也要有探求病因的习惯,找到了病因,治疗起来也许会事半功倍。

二、心动过速减慢,警惕电解质紊乱

病史简介

患者,女65岁,因“阵发性心慌胸闷气短10年,加重伴全身乏力2天”为主诉入院。

患者10年前因情绪激动后出现心慌胸闷气短,当时由120急诊来我院,诊断为“窦性心动过速”,经过住院治疗后病情稳定出院,出院后口服“酒石酸美托洛尔、稳心颗粒”等药物,病情稳定。

2天前因情绪激动出现心慌气短,胸闷,全身乏力,无胸痛,无恶心呕吐,无咳嗽咳痰,偶有头晕,无头痛。饮食正常,夜休差,二便正常。

既往:“高血压”病史6年,最高达170/90mmHg,口服“缬沙坦,吲达帕胺”,血压控制不佳。

入院查体:体温36.5℃,脉搏128次/分,呼吸22次/分,血压140/86mmHg。双肺呼吸音清,未闻及干湿性啰音,心率128次/分,律齐,心音可,各瓣膜听诊区未闻及病理性杂音。余查体未见明显异常。

入院查电解质:K:3.2mmol/L,立即给予补钾,1天后复查K:3.8mmol/L。

2天后,晚上值班,主管医生向我交班,随口说了句“病人情况稳定,就是现在心率稍微有一点慢。”病人病情稳定,我也没在意,晚上查房,听诊后,病人心率62次/分。可是患者的一句话引起了我的注意“来了几天了,今天突然感觉心跳的不那么快了。”难道是病情好转了?立即复查心电图,当看到心电图上高尖的T波我心头一震!赶紧复查电解质,结果回报K6.8mmol/L!经过紧张的降钾处理,到了清晨,复查电解K:5.3mmol/L。

通过这个病例,我们应该注意到,当患者心率减慢时,尤其是心动过速伴电解质紊乱时候,并不一定是病情好转的表现。补钾过程一定要慎之又慎,注意观察患者的临床表现,定期复查电解质。补钾不能过快,补钾不能过多;应用ACEI或者ARB类药物,注意其保钾作用。

临床工作无小事,对待病人,既要专业,又要细心,毕竟生命只有一次,我们要敬畏生命!

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=366182, encodeId=3bd736618252, content=学习了,有所得!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210124/2959859c08784950bc188459d8d7c2c1/3509ed0b3e3e4ca08f78e8a9232d2e4c.jpg, createdBy=24f61480129, createdName=小豁牙, createdTime=Mon May 13 23:09:53 CST 2019, time=2019-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250247, encodeId=79a325024e3a, content=谢谢分享.阅读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 04 09:07:53 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250197, encodeId=fd8425019e7c, content=讲的好.所有问题有不同原因, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 04 07:17:07 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250176, encodeId=56172501e6d4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Oct 04 06:59:01 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250174, encodeId=a83f2501e4ac, content=学习了很多先进的医疗技术, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Wed Oct 04 06:58:44 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250165, encodeId=43ae2501650c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Oct 04 06:13:44 CST 2017, time=2017-10-04, status=1, ipAttribution=)]
    2019-05-13 小豁牙

    学习了,有所得!

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=366182, encodeId=3bd736618252, content=学习了,有所得!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210124/2959859c08784950bc188459d8d7c2c1/3509ed0b3e3e4ca08f78e8a9232d2e4c.jpg, createdBy=24f61480129, createdName=小豁牙, createdTime=Mon May 13 23:09:53 CST 2019, time=2019-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250247, encodeId=79a325024e3a, content=谢谢分享.阅读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 04 09:07:53 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250197, encodeId=fd8425019e7c, content=讲的好.所有问题有不同原因, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 04 07:17:07 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250176, encodeId=56172501e6d4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Oct 04 06:59:01 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250174, encodeId=a83f2501e4ac, content=学习了很多先进的医疗技术, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Wed Oct 04 06:58:44 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250165, encodeId=43ae2501650c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Oct 04 06:13:44 CST 2017, time=2017-10-04, status=1, ipAttribution=)]
    2017-10-04 刘煜

    谢谢分享.阅读了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=366182, encodeId=3bd736618252, content=学习了,有所得!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210124/2959859c08784950bc188459d8d7c2c1/3509ed0b3e3e4ca08f78e8a9232d2e4c.jpg, createdBy=24f61480129, createdName=小豁牙, createdTime=Mon May 13 23:09:53 CST 2019, time=2019-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250247, encodeId=79a325024e3a, content=谢谢分享.阅读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 04 09:07:53 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250197, encodeId=fd8425019e7c, content=讲的好.所有问题有不同原因, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 04 07:17:07 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250176, encodeId=56172501e6d4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Oct 04 06:59:01 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250174, encodeId=a83f2501e4ac, content=学习了很多先进的医疗技术, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Wed Oct 04 06:58:44 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250165, encodeId=43ae2501650c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Oct 04 06:13:44 CST 2017, time=2017-10-04, status=1, ipAttribution=)]
    2017-10-04 yjs木玉

    讲的好.所有问题有不同原因

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=366182, encodeId=3bd736618252, content=学习了,有所得!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210124/2959859c08784950bc188459d8d7c2c1/3509ed0b3e3e4ca08f78e8a9232d2e4c.jpg, createdBy=24f61480129, createdName=小豁牙, createdTime=Mon May 13 23:09:53 CST 2019, time=2019-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250247, encodeId=79a325024e3a, content=谢谢分享.阅读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 04 09:07:53 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250197, encodeId=fd8425019e7c, content=讲的好.所有问题有不同原因, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 04 07:17:07 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250176, encodeId=56172501e6d4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Oct 04 06:59:01 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250174, encodeId=a83f2501e4ac, content=学习了很多先进的医疗技术, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Wed Oct 04 06:58:44 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250165, encodeId=43ae2501650c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Oct 04 06:13:44 CST 2017, time=2017-10-04, status=1, ipAttribution=)]
    2017-10-04 明月清辉

    谢谢分享.学习了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=366182, encodeId=3bd736618252, content=学习了,有所得!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210124/2959859c08784950bc188459d8d7c2c1/3509ed0b3e3e4ca08f78e8a9232d2e4c.jpg, createdBy=24f61480129, createdName=小豁牙, createdTime=Mon May 13 23:09:53 CST 2019, time=2019-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250247, encodeId=79a325024e3a, content=谢谢分享.阅读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 04 09:07:53 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250197, encodeId=fd8425019e7c, content=讲的好.所有问题有不同原因, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 04 07:17:07 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250176, encodeId=56172501e6d4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Oct 04 06:59:01 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250174, encodeId=a83f2501e4ac, content=学习了很多先进的医疗技术, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Wed Oct 04 06:58:44 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250165, encodeId=43ae2501650c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Oct 04 06:13:44 CST 2017, time=2017-10-04, status=1, ipAttribution=)]
    2017-10-04 雅文博武

    学习了很多先进的医疗技术

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=366182, encodeId=3bd736618252, content=学习了,有所得!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210124/2959859c08784950bc188459d8d7c2c1/3509ed0b3e3e4ca08f78e8a9232d2e4c.jpg, createdBy=24f61480129, createdName=小豁牙, createdTime=Mon May 13 23:09:53 CST 2019, time=2019-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250247, encodeId=79a325024e3a, content=谢谢分享.阅读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 04 09:07:53 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250197, encodeId=fd8425019e7c, content=讲的好.所有问题有不同原因, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 04 07:17:07 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250176, encodeId=56172501e6d4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Oct 04 06:59:01 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250174, encodeId=a83f2501e4ac, content=学习了很多先进的医疗技术, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Wed Oct 04 06:58:44 CST 2017, time=2017-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250165, encodeId=43ae2501650c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Oct 04 06:13:44 CST 2017, time=2017-10-04, status=1, ipAttribution=)]
    2017-10-04 龙胆草

    学习谢谢分享

    0

相关资讯

JACC:房内折返性心动过速是先心病常见的并发症

房性心律失常是先天性心脏病患者最常见的并发症之一。近日,在国际心血管权威杂志JACC上发表了一篇旨在评估先心病患者房性心律失常的类型、相关危险因素和发病年龄趋势的临床研究。本次多中心临床研究纳入了482例伴有房性心律失常的先心病患者,年龄为32.0 ± 18.0岁,女性占45.2%。患者心律失常的类型由有关专家评定。研究结果显示,患者最常见的心律失常是心房内折返性心动过速(IART),占所有患者的

急诊出诊的10个“陷阱”,你掉过几个?

急诊出诊时,我们会碰到很多的缓慢性心律失常患者,可能是良性的窦缓,也可能是“恶性”的三度,不同患者需要不同处理,处理恰当,可使患者迅速得到合理诊治,处理不当,轻者延误诊治,重者可危及患者生命。

BMC Med:别嘌醇可降低老年人室性心律失常风险?

有数据显示,痛风和高尿酸血症可能与心律失常相关,比如房颤(HF)。2017年3月,发表在《BMC Med》的一项由美国科学家进行的使用美国医疗保险数据的研究,考察了别嘌醇和老年人室性心律失常风险的相关性。

边诊断边治疗 层层深入“揪出”心律失常病因

患者男性,50岁,发作性心慌、头昏两年,因症状加重入院。考虑其症状可能与心律失常有关,并通过问诊及体格检查明确这一点。后心脏彩超检查提示有右心室可疑病变,考虑“致心律失常性右室心肌病”(ARVC)或“右室心肌致密化不全”。经紧急抗心律失常和降压处理,病情基本稳定。本病例一边进行治疗一边排除其他可能性,最终确诊为致心律失常性右室心肌病。

JACC:耐力型运动中的健康杀手:中暑比心律失常更常见

耐力型长跑中两个最重要的猝死原因已经证实是心律失常和中暑。然而一直以来,"心律失常"几乎吸引了所有医学界人士的关注,而中暑的重要性却一直无人问津。本项研究试图确定在耐力型竞赛中,中暑和心脏原因引起的危及生命事件的百分比。

肺叶切除,怎么就心律失常了?

5天前患者因肺癌行左肺上叶切除术后开始出现心悸,伴胸闷,呈阵发性,术后凌晨2:00-7:00心电监护示心率波动于40-150bpm之间,当地医院予输液等治疗(具体不详)。