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JAMA:低温症致Osborn波——案例报道

2016-07-06 Mechront 译 MedSci原创

患者男,79岁,既往有高血压、卒中、青光眼。护工发现他无应答后送到急诊。查体:触觉冷,血压85/55 mm Hg,心率36次/分,呼吸14次/分,血氧饱和度为100%。包括直肠测量体温在内的法子都没能测得患者的体温。双侧呼吸音清。胸片和头颅CT没有发现疾病病变。实验室检查结果还未出。开始给患者静脉滴注液体。心电图结果如下:P波衰减,严重窦性心动过缓。典型的Osborn波,低体温的特异性表现。诊断:

患者男,79岁,既往有高血压卒中、青光眼。护工发现他无应答后送到急诊。

查体:触觉冷,血压85/55 mm Hg,心率36次/分,呼吸14次/分,血氧饱和度为100%。包括直肠测量体温在内的法子都没能测得患者的体温。双侧呼吸音清。

胸片和头颅CT没有发现疾病病变。实验室检查结果还未出。

开始给患者静脉滴注液体。心电图结果如下:P波衰减,严重窦性心动过缓。


典型的Osborn波,低体温的特异性表现。


诊断:低温症。

治疗:热盐水和毛毯积极复苏,静脉予以改善低血压的药物。

预后:体温恢复正常后,Osborn波小时,但仍有PR和QT间期延长。住院期间患者确诊为金黄色葡萄球菌败血症,因为患者没有寒冷环境暴露史,目前考虑低温症与败血症有关。

值得一提的是,能正确识别这种特征性心电图(Osborn波)就能在患者复温前,避免不必要的干预,如心导管术或安置临时心脏起搏器。

对于Osborn波还需要多说一句,高钙血症、脑损伤、蛛网膜下腔出血、呼吸心跳骤停的发生、血管痉挛性心绞痛,和Brugada综合征时也能见到这种波。

下面介绍下低温症,指人体深部温度(直肠、食管、鼓室)低于35℃的状态。出现低温症的原因包括外伤、甲状腺功能减退、垂体功能减退、肾上腺功能减退、脓毒症、神经肌肉疾病、营养不良、维生素B1缺乏、低血糖、酒精滥用和一氧化碳中毒。治疗主要以尽快恢复体温、心肺复苏及妥善处理并发症为主。

原始出处:


Shah R, Rashid A, Mizeracki A.An Elderly Unresponsive Patient.JAMA. 2016 May 3;315(17):1896-7. doi: 10.1001/jama.2016.4462.

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    2016-10-12 1e0ece0dm09(暂无匿称)

    谢谢分享学习

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=146988, encodeId=9f4014698882, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Wed Oct 12 16:15:19 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128531, encodeId=791712853181, content=关注值得,学习。赞!好文探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=3, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 16 10:02:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=116862, encodeId=4a4311686228, content=赞!好文章,拜读,深入学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 09 19:53:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92215, encodeId=cd2892215bb, content=这么难!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151110/IMG5641A6F12C0732294.jpg, createdBy=2f901662448, createdName=乐奕11, createdTime=Thu Jul 07 12:24:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92179, encodeId=c8ed921e934, content=学习了,非常罕见的病, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Thu Jul 07 09:02:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92154, encodeId=b8f992154a3, content=学习了,涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:50:00 CST 2016, time=2016-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92153, encodeId=b57c921537d, content=?, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:49:00 CST 2016, time=2016-07-06, status=1, ipAttribution=)]
    2016-09-16 ylzr123

    关注值得,学习。赞!好文探究。

    0

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    2016-09-09 1e10c84am36(暂无匿称)

    赞!好文章,拜读,深入学习。

    0

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    2016-07-07 乐奕11

    这么难!!!!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=146988, encodeId=9f4014698882, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Wed Oct 12 16:15:19 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128531, encodeId=791712853181, content=关注值得,学习。赞!好文探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=3, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 16 10:02:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=116862, encodeId=4a4311686228, content=赞!好文章,拜读,深入学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 09 19:53:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92215, encodeId=cd2892215bb, content=这么难!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151110/IMG5641A6F12C0732294.jpg, createdBy=2f901662448, createdName=乐奕11, createdTime=Thu Jul 07 12:24:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92179, encodeId=c8ed921e934, content=学习了,非常罕见的病, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Thu Jul 07 09:02:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92154, encodeId=b8f992154a3, content=学习了,涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:50:00 CST 2016, time=2016-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92153, encodeId=b57c921537d, content=?, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:49:00 CST 2016, time=2016-07-06, status=1, ipAttribution=)]
    2016-07-07 oo902

    学习了,非常罕见的病

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=146988, encodeId=9f4014698882, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Wed Oct 12 16:15:19 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128531, encodeId=791712853181, content=关注值得,学习。赞!好文探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=3, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 16 10:02:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=116862, encodeId=4a4311686228, content=赞!好文章,拜读,深入学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 09 19:53:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92215, encodeId=cd2892215bb, content=这么难!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151110/IMG5641A6F12C0732294.jpg, createdBy=2f901662448, createdName=乐奕11, createdTime=Thu Jul 07 12:24:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92179, encodeId=c8ed921e934, content=学习了,非常罕见的病, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Thu Jul 07 09:02:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92154, encodeId=b8f992154a3, content=学习了,涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:50:00 CST 2016, time=2016-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92153, encodeId=b57c921537d, content=?, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:49:00 CST 2016, time=2016-07-06, status=1, ipAttribution=)]
    2016-07-06 ann y

    学习了,涨姿势了

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=146988, encodeId=9f4014698882, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Wed Oct 12 16:15:19 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128531, encodeId=791712853181, content=关注值得,学习。赞!好文探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=3, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 16 10:02:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=116862, encodeId=4a4311686228, content=赞!好文章,拜读,深入学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 09 19:53:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92215, encodeId=cd2892215bb, content=这么难!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151110/IMG5641A6F12C0732294.jpg, createdBy=2f901662448, createdName=乐奕11, createdTime=Thu Jul 07 12:24:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92179, encodeId=c8ed921e934, content=学习了,非常罕见的病, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Thu Jul 07 09:02:00 CST 2016, time=2016-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92154, encodeId=b8f992154a3, content=学习了,涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:50:00 CST 2016, time=2016-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92153, encodeId=b57c921537d, content=?, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Wed Jul 06 21:49:00 CST 2016, time=2016-07-06, status=1, ipAttribution=)]
    2016-07-06 ann y

    ?

    0

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