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患者女性,73岁,因间断发作性意识丧失50 d 于2004年12月25日入院。50 d 前患者无明显诱因突然出现意识丧失伴尿失禁,无肢体抽搐,持续数秒自行缓解,遗留全身乏力。后发作3次类似症状,持续均不足30 s。曾就诊于当地医院,心电图示偶发室性早搏。1 d 前症状再发来我院。既往有高血压史10余年,长期口服寿比山2.5 mg/d,血压控制在140/90 mmHg 左右。查体:BP 150/85 mmHg,神清语利,心、肺、腹及神经系统无异常。心电图示:窦性心律75次/min,电轴左偏30°,V_1～V_6可见宽大倒置 T 波,QT 间期0.54 s;血清钾2.6 mmol/L,钠133 mmol/L,氯87 mmol/L;心电监护示频发室性早搏、间断尖端扭转性室速(无症状)。考虑口服寿比山及肠道失钾致低钾血症,继发恶性室性心律失常、阿斯综合征。入院后停用寿比山,给予补钾、补镁及卡托普利降压治疗。第3 d 心电图示:V_1～V_6 T 波倒置变浅,QT 间期缩短0.44 s,但是治疗7 d 血清钾仅能维持3.3～3.4 mmol/L。考虑可能存在肾原性或内分泌疾病导致失钾。查腹部 CT 示:右肾上腺区可见1.0 cm 左右低密度结节,中度强化,考虑为右肾上腺醛固醇腺瘤,开始加服安体舒通60 mg/d。
Female patient, age 73, was admitted to hospital on December 25, 2004 after a 50-day loss of intermittent episodic consciousness. 50 d before the patient had no obvious incentive for a sudden loss of consciousness with incontinence, no limb twitch, continued for several seconds to ease themselves, leaving the body malaise. Post-episode 3 similar symptoms, sustained less than 30 s. Have visited a local hospital, ECG showed occasional premature ventricular contractions. 1 d before the recurrence of symptoms in our hospital. Past history of hypertension more than 10 years, long-term oral life than the Hill 2.5 mg / d, blood pressure control at 140/90 mmHg or so. Physical examination: BP 150/85 mmHg, Shen Qing language Lee, heart, lung, abdomen and nervous system without exception. Electrocardiogram: sinus rhythm 75 times / min, left axis deviation 30 °, V_1 ~ V_6 can be seen wide inverted T wave, QT interval 0.54 s; serum potassium 2.6 mmol / L, sodium 133 mmol / L, chlorine 87 mmol / L; ECG monitoring showed frequent premature ventricular contractions, intermittent torsades de pointes (asymptomatic). Consider oral administration of Longevity Hill and intestinal hypokalemia caused by hypokalemia, secondary malignant ventricular arrhythmia, Asperger syndrome. Suspension of life than the mountain after admission, given potassium, magnesium and captopril antihypertensive treatment. On the third day, the ECG showed that the T wave of V_1 ~ V_6 turned upside down and the QT interval shortened by 0.44 s. However, the serum potassium level maintained only 3.3 ~ 3.4 mmol / L on the 7th day. Consider the possible presence of nephrotic or endocrine disease leading to loss of potassium. Check the abdomen CT showed: right adrenal area can be seen about 1.0 cm low density nodules, moderate enhancement, consider the right adrenal aldosterone adenoma, began to add spironolactone 60 mg / d.