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男,75岁。于1993年4月5日入院。患者在6年前经常咳嗽,咯粘液痰,以秋冬发作,天气变化时加重。曾因咳嗽加重在本院住院,诊为“慢性阻塞性肺疾病”。3天前因咳嗽加剧,伴气促入院,无发热、胸痛、咯血。入院体查:BP14/9kPa,神志清,自动体位、呼吸稍促、浅表淋巴结无肿大,颈静脉无充盈,桶状胸,双肺可闻干湿啰音,心界不大,心率108次/分,律整、肝脾未扪及,下肢无浮肿。曾用先锋霉素Ⅵ、西力欣、激素、氨茶硷等处理,症状无缓解,反而气促日渐加重,曾有阵发性房颤、频发房早、短暂房速等心律失常。4月13日查房:BP 15/8kPa,半卧位、左锁骨上可扪及2颗0.5×0.8cm淋巴结,质硬,颈静脉怒张,双肺可闻散在湿啰音,心界扩大,心率110次/分,律不整,肝肋下4cm,下肢轻度浮肿,有奇脉。超声心动图:心包积液(大量);胸片:对照上次胸片,心影明显增大;心电图:窦性心动过速,频发房性早搏,肢体导联低电压,Ⅱ、Ⅲ、aVF导联T波倒置,余导联T波低平。
Male, 75 years old. Admitted to hospital on April 5, 1993. 6 years ago, patients often cough, slightly sticky sputum to fall and winter seizures, the weather changes worse. Have increased hospitalizations for cough, diagnosed as “chronic obstructive pulmonary disease.” 3 days ago due to increased cough, with gas into the hospital, no fever, chest pain, hemoptysis. Admission physical examination: BP14 / 9kPa, clear consciousness, automatic position, breathing a little faster, superficial lymph nodes without swelling, no filling of the jugular veins, barrel chest, lungs can be heard wet and dry rales, heart, heart rate 108 Times / min, law, liver and spleen not palpable, lower extremity no edema. Has used cephalosporins Ⅵ, celecoxib, hormones, ammonia theophylline and other treatment, no relief of symptoms, but the gas is getting worse, had paroxysmal atrial fibrillation, frequent room early, short-term atrial arrhythmia. April 13 rounds: BP 15 / 8kPa, semi-recumbent position, the left clavicle palpable 2 0.5 × 0.8cm lymph nodes, hard, jugular vein engorgement, lungs can be heard scattered in the wet rales, expanding heart , Heart rate 110 beats / min, irregular law, liver ribs 4cm, lower extremity mild edema, there Qi pulse. Echocardiography: pericardial effusion (a large number); chest X-ray: control chest X-ray, heart shadow increased significantly; ECG: sinus tachycardia, frequent atrial premature beats, aVF lead T wave inversion, lead T wave low flat.