论文部分内容阅读
风湿性钙化性主动脉瓣病变是较少见的疾病,主要病理改变是三个半月瓣互相粘连、增厚、变硬、挛缩和钙化。值得注意的是,在此基础上出现瓣膜穿孔,并在穿孔处形成一完整血栓,实属罕见,现将我院一例报告如下。患者,男,40岁,因劳累后心悸半年,加重伴腹胀、纳差三月,于1985年2月5日入院。体检;T35.9℃,P96次,R24次,BP140/62,半卧位,慢性病容,颈静脉轻度怒张,两侧颈动脉可见异常搏动,右颈动脉处可闻及双期杂音。胸廓无畸形,双肺(-) 心尖搏动弥散在左第五肋锁骨中线外2cm处,范围约4×4cm~2。未扪及震颤,心界向两侧扩大,心尖区可闻及Ⅲ级吹风样缩鸣及柔和舒张期杂音,主动脉瓣副区可音Ⅵ+级租糙吹风样缩鸣及递减型全舒张期杂音;主动脉瓣区可闻Ⅱ+级吹风样缩鸣及柔和舒张期杂音并向右颈部传导。心率同脉搏,律齐,心音减弱。双上肢可扪及水冲脉,右腹股沟可闻及枪击音。肝上界在右锁骨中线第五肋间,肋下2cm,剑下4cm,质中,轻压痛;肝颈回流征阳性。脾未扪及。
Rheumatic calcified aortic valve disease is a rare disease, the main pathological changes are three and a half months valve adhesion, thickening, hardening, contracture and calcification. It is noteworthy that, on this basis, valve perforation, and the formation of a complete thrombus in the perforation, it is rare, now a hospital in our report as follows. Patients, male, 40 years old, palpitations after exertion for six months, aggravated with abdominal distension, anorexia March, on February 5, 1985 admission. Physical examination; T35.9 ℃, P96, R24 times, BP140 / 62, semi-recumbent, chronic disease, mild jugular vein engorgement, abnormal beats on both sides of the carotid artery, right carotid artery can be heard and double noise. Thoracic deformity, lung (-) apex beat dispersed in the left fifth rib clavicle 2cm outside the midline, the range of about 4 × 4cm ~ 2. Not palpable tremor, the heart bound to expand on both sides of the apex can be heard and Ⅲ grade hair-like systolic and diastolic murmur noise, the aortic valve can be voiced Ⅵ class level rough hair blowing shrinkage and diminished total relaxation Period murmur; aortic valve area can be heard Ⅱ + class hair-like contraction and soft diastolic murmur and conduction to the right neck. Heart rate with the pulse, law Qi, heart sounds weakened. Double upper limb palpable water pulse pulse, the right groin can be heard and shot sound. Liver upper bound in the right intercostal midline fifth intercostal rib 2cm, sword 4cm, quality, mild tenderness; liver reflux syndrome positive. Spleen not palpable.