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asbryobvrz · Wysłany: Pią 14:19, 25 Mar 2011

Chediak-Higashi syndrome

0mmol / L, check ECG: atrial fibrillation, cardiac insufficiency. Patients with middle-aged women with hypertension, hyperlipoproteinemia history, history of typical angina pectoris and the use of the expansion history of coronary artery was diagnosed as a drug active coronary heart disease, atrial fibrillation. Grade Ⅱ after admission given medical care, low-fat diets, 12 'service isosorbide mononitrate 1Omg, 2 times / d, enalapril maleate 10mg, 2 times / d, verapamil 80mg, 3 times / d, given 5% glucose solution 500ml-4-Danshen solution 2Oml, intravenous infusion, 1 / d. Alleviate symptoms in patients, occasional palpitations, check heart rate 130; P. . / Min, in order to reduce heart rate, Zhu Huanzhe after lunch, 12 'service (the date of the unit: 056 001 Department of Gastroenterology, Central Hospital of Handan, Hebei Province, 13:0 o) propranolol 10mg, 3h later (15:00) conscious patients with respiratory difficulties, flustered, Charlie 12 'lip cyanosis, coarse breath sounds lungs, heart rate 5O times / min, atrial fibrillation is still legal. That is, to oxygen, 5% glucose solution 500ml + Nitroglycerin 5mg, 2O drops / min maintenance infusion, and then the symptoms gradually worsened, facial cyanosis, severe difficulty in breathing, blood pressure 8/5kPa, heart rate 36 times / min, Jicha electrocardiogram, atrial fibrillation combined Ⅱ degree atrioventricular block, consider the use of propranolol and verapamil inhibit the AV Ng cardiogenic shock due to, that is, to 0.9% sodium chloride solution 250ml + dopamine 4Omg + aramine 3Omg, 2O drops / min, intravenous infusion, poor efficacy. In medication 5h (18:00) atropine 1mg, repeated intravenous tube into the (total 1Omg), heart rate, blood pressure gradually recovered in 10min, at 21:00 heart rate rose to 67 ~ L / min, blood pressure 13/8kPa , significantly reduced in patients with symptoms, the symptoms disappeared in 22:00 patients, review of ECG atrial fibrillation, ventricular rate of 100 ~ L / min, Ⅱ degree atrioventricular block disappeared,[link widoczny dla zalogowanych], stop treatment. Rheology check the next day increased whole blood viscosity, fibrinogen increased 0.9% sodium chloride solution was added 100ml-4-defibrase 51u,[link widoczny dla zalogowanych], intravenous infusion, 1 / d. 1 week after admission in patients with symptoms, heart rate l1O ~ L / min. Half months after treatment discharge. 2 is a clinical discussion of verapamil a calcium channel blocker commonly used, it can block the flow ca, inhibit electrical activity of sinus node and atrioventricular node slow reaction time performance, so that the sinus node and the Housing atrioventricular node of self-regulation reduced the action potential ... 0 'phase and amplitude of the maximum rate of rise decreases, and thus heart rate, atrioventricular conduction time longer, so the symptoms of supraventricular tachycardia, rapid atrial fibrillation slow down the heart rate. The 13 a-blocker propranolol can inhibit the cardiac adrenergic receptor agonist of 13 of a reactive, slow diastolic depolarization rate, reducing myocardial cell self-discipline, slow impulse conduction speed, so that the relative extension of effective refractory period, but also slow down the heart rate and atrioventricular role. Therefore, for the elimination of self-discipline and exhumation of excitement caused by increased supraventricular and ventricular arrhythmias. During combination of the two drugs slow down the heart rate and its role in atrioventricular conduction delay increases, can cause severe atrioventricular block, cardiac arrest, it is an absolute incompatibility between the two. At the same time application of verapamil and pindolol, metoprolol, also observed a similar effect, however, verapamil and the other p-blockers atenolol, timolol, sodium Duoluo Er, etc.,[link widoczny dla zalogowanych], and propranolol, and the other between classes of calcium antagonist verapamil, verapamil, such as thiophene,[link widoczny dla zalogowanych], Gallo pamidronate, Falipami, etc. will occur between the above effects have not been reported, but pharmacological similar effect, it may happen, it is not appropriate application compatibility. Small number of patients with propranolol and nifedipine in blood pressure and heart failure occurred. Although the B-blockers and calcium channel antagonists other leather interaction of diltiazem have not reported adverse effects, but many of the reforms of diltiazem and verapamil, the same pharmacological properties, it is also possible] . Also reported by disabled after 24h of verapamil propranolol to avoid this effect, for safety reasons, the process in the application of propranolol,[link widoczny dla zalogowanych], we still need further clinical observation.