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患者女,58岁,因反复咳嗽、咳痰10年,加重5天,于1998年6月以慢性支气管炎并肺部感染收入住院,发病以来无盗汗、胸痛、心悸及气促。既往无冠心病及药物过敏史。查体:T 38.4℃,R19次/min,BP110/70mmHg,口唇无发绀,颈静脉无怒张,双肺呼吸音粗,双下肺可闻及湿性啰音,心脏和腹部未见异常。血常规:白细胞12.5×10~9/L,N 0.89,胸片为慢性支气管炎并肺部感染。入院诊断:慢性支气管炎和肺部感染,予抗感染、止咳化痰等治疗。常规青霉素皮试阴性,用0.9％氯化钠注射液100ml+哌拉西林钠(氧哌嗪青霉素)3g静滴,滴至20分钟时患者突然心悸、胸闷、气促伴出冷汗,查体:T36℃,R24次/min,BP70/45mmHg,面色苍白,口唇及四肢末端发绀,湿冷,考虑为哌拉西林致过敏性休克,给予抗过敏治疗,立即撤换为5％葡萄糖注射液静滴、吸氧,约30分钟症状未缓解,并且患者又诉胸部剧烈疼痛,伴气促加重、烦燥不安。急查心电图提示多导联出现异常高大、不对称的T波及ST段抬高,考虑为休克诱发急性心梗,采取溶栓、营养心肌等综合性治疗,2周后症状消失,恢复正常,痊愈出院,随防1年无特殊变化。
The female patient, aged 58, was admitted to the hospital for chronic bronchitis and pulmonary infection in June 1998 due to repeated cough and sputum for 10 years and 5 days of exacerbation. There was no night sweats, chest pain, palpitation and shortness of breath since the onset of her illness. No past history of coronary heart disease and drug allergy. Examination: T 38.4 ℃, R19 times / min, BP110 / 70mmHg, no cyanosis of the lips, no jugular vein engorgement, lung breath sounds coarse, double lungs can be heard and wet rales, no abnormalities in the heart and abdomen. Blood: white blood cells 12.5 × 10 ~ 9 / L, N 0.89, chest for chronic bronchitis and pulmonary infection. Admission diagnosis: chronic bronchitis and lung infection, to anti-infection, cough and phlegm and other treatment. Conventional penicillin skin test negative, with 0.9% sodium chloride injection 100ml + piperacillin sodium (piperacillin penicillin) 3g intravenous infusion of 20 minutes when the patient suddenly palpitations, chest tightness, shortness of breath with cold sweat, physical examination: T36 ℃, R24 times / min, BP70 / 45mmHg, pale, lips and extremities cyanosis, wet and cold, consider the piperacillin-induced anaphylactic shock, given anti-allergy treatment, immediately replaced by 5% glucose injection intravenous infusion of oxygen , About 30 minutes did not alleviate the symptoms, and patients also complained of severe chest pain, with increased urgency, irritability. Emergency ECG prompted multi-lead appeared abnormally tall, asymmetric T wave and ST segment elevation, consider shock-induced acute myocardial infarction, thrombolytic therapy, nutritional myocardium and other comprehensive treatment, symptoms disappeared after 2 weeks, returned to normal, recovered Discharged, with 1 year without special changes.