病历摘要男患,48岁,有25年吸烟史。1986年因右足部麻木、凉、疼痛、间歇跛行,曾做下肢阻抗血流图并诊断为“血栓闭塞性脉管炎”,长期服中药治疗,病情时有反复。1991年3月31日晨起突然自觉胸闷,4小时后来院,在就诊过程中突然昏倒。查体:神志恍惚、面色苍白、四肢厥冷、血压测不出。呼吸30次/分,第一心音减弱,心界不大,心率64次/分,右足背动脉搏动明显减弱,血压回升后右桡动脉搏动触不清。心电图:ST Ⅱ、Ⅲ、avF 抬高呈单向曲线,STV_2+V_4水平下降24小时后出现异常,Q Ⅱ、ⅢavF。谷丙转氨酶1166.9nmol.s~(-1)/L 乳酸脱氢酶753.40nmol/L,肌磷酸激酶1185.4nmol/L,α-羟丁酸脱氢酶3.87pmol/L。血脂、肝功、血糖、血流变学均正常。治疗:立即给予尿激酶、硝酸甘油、硝普钠、低分子右旋糖酐及对症治疗。病情逐渐好转,但16天后心电图 V_1R>S,且出现 Medical history male suffering, 48 years old, 25 years of smoking history. In 1986 due to numbness of the right foot, cold, pain, intermittent claudication, had lower extremity impedance blood flow map and diagnosed as “thromboangiitis obliterans”, long-term Chinese medicine treatment, the disease repeatedly. March 31, 1991 morning suddenly felt chest tightness, 4 hours later to hospital, suddenly collapsed in the treatment process. Physical examination: trance, pale, extremities Jueleng, blood pressure can not be measured. Breathing 30 beats / min, the first heart sound weakened, the heart is not big, heart rate 64 beats / min, right foot dorsal artery pulsation significantly weakened, blood pressure rise right pulsatile pulse pulsation. ECG: ST Ⅱ, Ⅲ, avF elevated showed a one-way curve, STV_2 + V_4 level down 24 hours after the abnormal, Q Ⅱ, ⅢavF. Alanine aminotransferase 1166.9nmol s ~ (-1) / L lactate dehydrogenase 753.40nmol / L, myokinase 1185.4nmol / L, α-hydroxybutyrate dehydrogenase 3.87pmol / L. Blood lipids, liver function, blood glucose, blood rheology were normal. Treatment: Immediately given urokinase, nitroglycerin, sodium nitroprusside, low molecular weight dextran and symptomatic treatment. Condition gradually improved, but after 16 days the ECG V_1R> S, and appear