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病例30-2020——一名心脏骤停的54岁男性
Case 30-2020 — A 54-Year-Old Man with Sudden Cardiac Arrest


Elazer R. Edelman ... 心脑血管疾病 • 2020.09.24

病例陈述


Jacqueline B. Henson医师(内科):一名54岁男性发生与心室颤动相关的心脏停搏后,在本院接受了检查。

该患者此前一直健康状况如常,但入院当日中午突然在一家快餐店里喘不过气来并且全身颤抖、意识丧失。患者的全身颤抖很快停止,但仍然无反应。急救人员约4分钟后到达,开始心肺复苏(CPR)。患者心律为心室颤动;急救人员给予患者4次电击,并静脉给予纳洛酮、胺碘酮,并且推注肾上腺素,之后连续输入肾上腺素。患者心律缓慢且QRS波群宽,心率为40次/分,据报告当时患者的精神状态恢复,但再次出现无脉搏之后必须继续实施CPR。

患者在首次心脏停搏后30分钟被送抵本院,无反应,中年男性,之前接受了机械CPR,且无创伤的外部表现。我们经验性地静脉给予患者氯化钙、葡萄糖、胰岛素及碳酸氢钠。此外,静脉给予血管升压素、去甲肾上腺素、罗库溴铵和氯胺酮,经直肠给予阿司匹林。行紧急气管插管,经口置入胃管,置入股动脉导管,并且经股静脉置入中心静脉导管。





作者信息

Elazer R. Edelman, M.D., Ph.D., Neel M. Butala, M.D., M.B.A., Laura L. Avery, M.D., Andrew L. Lundquist, M.D., Ph.D., and Anand S. Dighe, M.D., Ph.D.
From the Department of Medicine, Brigham and Women’s Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School — all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.).

 

参考文献

1. Revers FE. Heeft succus liquiritiae een genezende werking op ce maagzweer? Ned Tijdschr Geneeskd 1946;90:135-137.

2. Revers FE. De behandling van ulcus ventriculi en ulcus duodeni met succus liquiritiae. Ned Tijdschr Geneeskd 1948;92:2968-2973.

3. Molhuysen JA, Gerbrandy J, de Vries LA, et al. A liquorice extract with deoxycortone-like action. Lancet 1950;2:381-386.

4. Deutch MR, Grimm D, Wehland M, Infanger M, Krüger M. Bioactive candy: effects of licorice on the cardiovascular system. Foods 2019;8:495-495.

5. Garcia A, Rasmussen HH, Apell H-J, Clarke RJ. Kinetic comparisons of heart and kidney Na+,K(+)-ATPases. Biophys J 2012;103:677-688.

6. Matchkov VV, Gustafsson H, Rahman A, et al. Interaction between Na+/K+-pump and Na+/Ca2+-exchanger modulates intercellular communication. Circ Res 2007;100:1026-1035.

7. Farese RV Jr, Biglieri EG, Shackleton CH, Irony I, Gomez-Fontes R. Licorice-induced hypermineralocorticoidism. N Engl J Med 1991;325:1223-1227.

8. Kamel KS, Ethier JH, Richardson RMA, Bear RA, Halperin ML. Urine electrolytes and osmolality: when and how to use them. Am J Nephrol 1990;10:89-102.

9. Kato H, Kanaoka M, Yano S, Kobayashi M. 3-Monoglucuronyl-glycyrrhetinic acid is a major metabolite that causes licorice-induced pseudoaldosteronism. J Clin Endocrinol Metab 1995;80:1929-1933.

10. Palmer BF, Clegg DJ. Physiology and pathophysiology of potassium homeostasis: core curriculum 2019. Am J Kidney Dis 2019;74:682-695.

11. Mumford E, Unwin RJ, Walsh SB. Liquorice, Liddle, Bartter or Gitelman — how to differentiate? Nephrol Dial Transplant 2019;34:38-39.

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