患者男,30岁,主因"意识丧失4h"于2021年4月26日入我科.4h前(13:00左右),患者因胸闷自行至我院呼吸科门诊就诊,候诊期间出现意识丧失,院内急救团队到达后查看患者意识丧失,大动脉搏动未触及,心电图示心室颤动(见图1),立即行心肺复苏术,200J电除颤共6次,持续性心外按压,气管插管辅助呼吸,期间患者呕吐大量胃内容物.

病例1,男性,44岁,主诉"活动后呼吸困难伴胸闷1个月",每次发作持续数分钟至2h,在外院拟诊断"不稳定性心绞痛",而行冠脉造影,结果未见明显狭窄.患者因上述症状反复发作,并出现双下肢轻度凹陷性水肿,于2020年11月16日入我院.入院后查心电图(图1,见封3)提示:窦性心律,一度房室传导阻滞,R波上升不良,异常Q波,全导联低电压,ST-T改变.超声心动提示:双房增大,室间隔增厚,左室舒张功能减低,LVEF 47％,心肌淀粉样变性可能.NT-proBNP 8126pg/ml,cTnT 0.050ng/ml.免疫球蛋白定量:IgG 418.0mg/dl,IgA 64.9mg/dl,IgM 10.2mg/dl,κ轻链(血)339mg/dl、λ轻链(血)224mg/dl、κ/λ(血)1.5 13,κ轻链(尿)＜1.85mg/dl、λ轻链(尿)338mg/dl,24h总尿量700ml,λ轻链(尿)2366mg/24h,结果分析:LAM型M蛋白血症.骨髓涂片提示浆细胞占31％,多发性骨髓瘤诊断明确.出院诊断:多发性骨髓瘤,心肌淀粉样变性,慢性心力衰竭,心功能Ⅲ级(NYHA分级),低钾血症.随访:血液科给予硼替佐米化疗.

Objective To investigate the relationship between Child-Pugh grade of liver cirrhosis patients and ratecorrected QT interval(QTc)of electrocardiogram.Methods Compared with the normal controls,electrocardiogram of 30 liver cirrhosis patients are analyzed.The relationship between QTc and Child-Pugh grade was analyzed.Results The electrocardiogram of liver cirrhosis patients has many kinds of abnormality.QTc was more prolonged than the normal controls(0.447±0.031 s vs 0.372±0.038 s,P=0.000).QTc was positively correlated with Child-Pugh grade.A grade(0.427±0.013) s;B grade(0.446±0.024) s;C grade(0.468±0.038) s;Spearman 0.550,P=0.002;Kendall 0.443,P=0.003).Conclusion The electrocardiogram of liver cirrhosis patients has many kinds of abnormality.QTc was positively correlated with the severity of liver cirrhosis.

<正>患者女性,48岁,主因"全身乏力、胸闷6d,加重1d"于呼吸科就诊。门诊心电图(图1)示:窦性心律,心率116次/min,V1~V4导联ST段弓背样抬高0.2~0.5mv,Ⅱ、Ⅲ、avF导联ST段弓背样抬高0.05~0.15mv,I、avL导联呈QS型。心电图诊断:窦性心动过速,怀疑前壁、下壁急性心肌