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1 病例资料女性,67岁,有“风湿性心脏病”史40年。慢性心力衰竭反复发作10余年。因尿少及心悸、气短加重2天于1994年2月13日11时30分急诊。来院前一直服用地高辛0.25 mg、0.125 mg,隔日交替;丁尿胺3 mg,呋喃苯胺酸60 mg,隔日交替;氨体舒通40 mg 3次/日,缓释钾1.0 g3次/日及卡托普利25 mg,2次/日。查体:心率40次/分,血压12/8 kPa(90/60 mmHg),神志清,45°斜坡卧位,心尖部及胸骨右缘第2肋间可闻及双期杂音,双肺底可闻及小湿啰音。心电图示心房颤动伴高度交界区传导阻滞。血清钾7.44 mmol/L,尿素氮22 mmol/L,肌酐225 μmol/L,二氧化碳结合力7mmol/L。临床诊断:①慢性风湿性联合瓣膜病,心功能Ⅳ级,心房颤动伴高度交界区传导阻滞。②肾功能不全、高钾血症、代谢性酸中毒。治疗给予呋喃苯胺酸100mg静脉注射及碳酸氢钠100 ml静脉滴注,葡萄糖+
1 Case Information Female, 67 years old, with “rheumatic heart disease” history of 40 years. Chronic heart failure recurrent more than 10 years. Because of oliguria and palpitations, shortness of breath increased 2 days at 11:30 on February 13, 1994 emergency. Digoxigenin 0.25 mg, 0.125 mg, alternating every other day; 3 mg of butanil, 60 mg of furosemide, alternating every other day; Thymidine 40 mg 3 times / day, slow release potassium 1.0 g 3 times / day And captopril 25 mg, 2 times / day. Physical examination: heart rate 40 beats / min, blood pressure 12/8 kPa (90/60 mmHg), conscious mind, 45 ° supine position, apex and sternum right intercostal 2 intercostal can hear and double murmurs, Can be heard and small wet rales. ECG shows atrial fibrillation with a high junction block. Serum potassium 7.44 mmol / L, urea nitrogen 22 mmol / L, creatinine 225 μmol / L, carbon dioxide binding 7mmol / L. Clinical diagnosis: ① chronic rheumatic joint valvular heart disease, grade Ⅳ, atrial fibrillation with a high junction block. ② renal insufficiency, hyperkalemia, metabolic acidosis. Treatment given furosemide 100mg intravenous infusion and sodium bicarbonate 100ml intravenous infusion of glucose +