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临床资料患者女,67岁,农民,因突发心悸2 h 伴晕厥5 min 于2005年3月8日由急诊收入肾内科。检查 T:35.5℃,R31次/min,BP 180/110 mmHg,神志不清,烦躁,双瞳孔对光反射略迟钝,HR 155次/min,血钾9.2 mmol/L,BUN 25.5 mmol/L,cr 783μmol/L,诊断慢性。肾功不全,高钾血症,ECG 示室性心动过速,病情危急,经家属同意,紧急血液透析3 h,血钾降至6.7mmol/L,转为窦性心律(56次/min),神志转清,回答切题。第二、第三日各予3 h 血液透析,血钾降至5.6 mmol/L→3.9 mmol/L,下床活动,后自动出院。复习病史,患者于15个月前曾因突发胸闷、心悸1 h 收住本科,血钾8.7 mmol/L,肾功能减损,拟诊慢性肾功不全、高钾血症。经用钙剂、胰岛素、碳酸氢钠等药物治疗4 d 后,血钾降至5.8 mmol/L,胸闷消失,自动出院。
Clinical data Patients Female, 67 years old, farmer, due to sudden heart palpitations 2 h with syncope 5 min on March 8, 2005 from the emergency department of renal medicine. Check T: 35.5 ℃, R31 times / min, BP 180/110 mmHg, confusion, irritability, double pupil light reflex a little blunt, HR 155 beats / min, serum potassium 9.2 mmol / L, BUN 25.5 mmol / cr 783μmol / L, diagnosis of chronic. Renal insufficiency, hyperkalemia, ECG ventricular tachycardia, critical condition, with family consent, emergency hemodialysis 3 h, serum potassium decreased to 6.7mmol / L, to sinus rhythm (56 beats / min) Mind clear, answer the question. On the second and the third day, hemodialysis was performed every 3 h, the serum potassium decreased to 5.6 mmol / L → 3.9 mmol / L, and the patients were discharged from bed after being out of bed. Review of medical history, patients 15 months ago due to sudden chest tightness, palpitations 1 h admitted to undergraduate, serum potassium 8.7 mmol / L, impaired renal function, diagnosed chronic renal insufficiency, hyperkalemia. After 4 days of treatment with drugs such as calcium, insulin and sodium bicarbonate, serum potassium decreased to 5.8 mmol / L, chest tightness disappeared and discharged automatically.