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预激综合征(WPW)并发AVRT(房室折返性心动过速)以O-AVRT(顺向型)多见,多为窄QRS型心动过速.当发生功能性束支阻滞时,与A-AVRT(逆向型)一样表现为宽QRS心动过速,对血流动力学影响更明显.在诊断上与室速不易鉴别,在治疗上应首选心律平.笔者在临床上遇到1例,多次并发阵发性室上性心动过速(PSVT),用维拉帕米静脉推注获得迅速转复的疗效.今报道如下.患者,男,22岁.7个月来多次因心悸、胸闷、胸痛、心动过速发作就诊.就诊前发作时间最长3h,最短10min.既往心电图提示WPW.听诊心率多在180～220次/分,节律整齐.各瓣膜未闻及病理性杂音.血压在10～12/8kPa.发作时心电图均见QRS宽大畸形,均齐,时限0.14～0.16s,室率187次/分,R-R间期320ms,心电轴左偏.大部分导联P’波不可辨认.QRS波群Ⅰ、Ⅱ、aVL、V_5呈R型,aVF、V_3呈Rs型,V_1呈rS型,Ⅲ、aVR呈QS型.就诊中2次自行转复,余5次均在心电图监护下用维拉帕米5mg+50%葡萄糖20ml缓慢静脉推注,当注射至4mg左右
Prewave syndrome (WPW) complicated by AVRT (atrioventricular reentrant tachycardia) O-AVRT (cis type) more common, mostly narrow QRS tachycardia when functional bundle branch block, and A-AVRT (reverse type) as the performance of wide QRS tachycardia, hemodynamics more obvious in the diagnosis and VT is not easy to identify, should be preferred in the treatment of cardiac rhythm. I encountered in clinical cases of 1 case , Multiple concurrent paroxysmal supraventricular tachycardia (PSVT), with intravenous injection of verapamil to obtain the rapid recovery of the efficacy.This report is as follows.Patients, male, 22 years old .7 months to many times due to Palpitations, chest tightness, chest pain, tachycardia episodes of treatment before treatment time of up to 3h, the shortest 10min. Previous ECG prompts WPW. Auscultatory heart rate more in the 180 ~ 220 beats / min rhythm of the valve is not known and pathological noise .Blood pressure in the 10 ~ 12 / 8kPa .Electrocardiogram showed QRS large deformity, homogeneous, time 0.14 ~ 0.16s, room rate of 187 beats / min, RR interval of 320ms, left axis of ECG .Most lead P ’Wave can not be identified.QRS wave group Ⅰ, Ⅱ, aVL, V_5 was R type, aVF, V_3 was Rs type, V_1 was rS type, Ⅲ, aVR was QS type. In ECG custody Verapamil 5mg + 50% glucose 20ml slow intravenous injection, when injected to about 4mg