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患者女性,18岁。因发现心脏杂音10年余入院。病人平素心悸、乏力,活动时明显,无紫绀。查体:双肺呼吸音粗,心音清,律整,心率90次/分,胸骨左缘第Ⅲ肋间可闻及Ⅲ级粗糙收缩期吹风样杂音,伴有震颤,P_2亢进。Doppler超声检查诊为先天性心脏病室间隔膜部缺损(直径2.2～2.5cm)。鉴此,给予行体外循环室间隔修补术。修补完毕心脏复跳后,表现为Ⅲ度房室传导阻滞(原为窦性心律),室率40次/分。静推阿托品、地塞米松后,房室传导功能不能改善。考虑可能为手术误伤房室传导系统所致。用异丙基肾上腺素后难以维持理想心率。基
Patient female, 18 years old. Because of heart murmur more than 10 years admitted to hospital. Patients usually palpitations, fatigue, obvious activity, no cyanosis. Physical examination: lung breath sounds thick, heart sound clear, law, heart rate 90 beats / min, the left sternal third intercostal smell and grade Ⅲ rough systolic hair-like murmur, accompanied by tremor, P 2 hyperthyroidism. Doppler ultrasound diagnosis of congenital heart disease Department of ventricular septal defect (diameter 2.2 ~ 2.5cm). Given this, given extracorporeal circulation ventricular septal repair. After repair heart rebound, manifested as Ⅲ degree atrioventricular block (formerly sinus rhythm), room rate 40 beats / min. Static push atropine, dexamethasone, atrioventricular conduction function can not be improved. Consider may be due to surgical injury to atrioventricular conduction system. After using isoproterenol is difficult to maintain the ideal heart rate. base