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一般认为低钾很少产生传导阻滞,临床上低血钾导致房室传导阻滞(AVB)者少见。我院近年来收治的低血钾软病和周期性麻痹患者中有4例合并AVB。现报告如下。 病历摘要 例1:女患,38岁,农民。因四肢软弱无力伴心悸、胸闷10天于1984年4月5日入院。体检:体温36.5℃,血压13.3/8.00KPa,神清,抬头困难,心率80次/分,心律不齐,每分钟有7～8次早搏及漏搏,未闻及杂音。四肢肌张力低,肌力双上肢Ⅲ级,双下肢Ⅰ～Ⅱ级,两侧膝反射消失。有长期食用粗制棉籽油史。无类似发作史。化验:血清K~+1.70mmol/L,Na~+128mmol/L、Cl~-146mmol/L、Ca~(++)2.7mmol/L,CO_2CP23.3mmol/L(51.9Vol％)。心电图:①Ⅱ°Ⅰ型AVB;②频发室性早搏;⑧各导联T波低平,Q—T间期延长。拟诊为低血钾软病,给予氯化钾3克/日口服,以0.2％浓度静滴氯化钾3克/日,入院第4天因严重室性心律失常突然死亡。
Hypokalemia is generally believed that there is very little conduction block, clinical hypokalemia lead to atrioventricular block (AVB) is rare. In our hospital admitted in recent years, hypokalemia and periodic paralysis in patients with 4 cases of AVB. The report is as follows. Case history summary 1: female patient, 38 years old, farmer. Due to limb weakness with palpitations, chest tightness 10 days in 1984 April 5 admission. Physical examination: body temperature 36.5 ℃, blood pressure 13.3 / 8.00KPa, God clear, head difficulties, heart rate 80 beats / min, arrhythmia, beats by dre, 7 to 8 times per minute premature beats and leakage stroke, no smell and noise. Limb muscle tension is low, muscle strength of upper extremity Ⅲ, double extremity Ⅰ ~ Ⅱ level, both sides of knee reflex disappeared. Long-term consumption of crude cottonseed oil history. No history of similar attacks. Assay: Serum K ~ 1.70mmol / L, Na ~ + 128mmol / L, Cl ~ -146mmol / L, Ca ~ (++) 2.7mmol / L, CO_2CP23.3mmol / L (51.9Vol%). ECG: ① Ⅱ ° Ⅰ type AVB; ② frequent premature ventricular contractions; ⑧ each lead T-wave flat, Q-T interval prolongation. To be diagnosed as hypokalemia soft disease, given potassium chloride 3 g / day oral 0.2% concentration of potassium chloride infusion 3 g / day, admitted to hospital the fourth day of sudden death due to severe ventricular arrhythmia.