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病例报告例1:女,74岁。糖尿病史15年,平时从未节制饮食和未用系统降血糖药物治疗。1987年以来,每年冬季足趾、足跟和手指等处反复发生黄豆至小枣大小之水疱,无痛痒,多于2～3周内自愈。1989年2月6日因心慌气喘伴全身浮肿收住院。入院检查:血压23.9/12.8千帕,精神萎靡,呼吸困难。全身皮肤水肿,口唇紫绀,颈静脉怒张,两肺可闻及湿性啰音穆?6次/分,心音低钝,可闻及第四心音。两侧足趾足跟和手指、左足侧、右前臂及耳廓等处可见大小不等之清晰水疱,疱壁紧张、透明,周围无红肿。其中左外踝下方一大水疱约7.0厘米×6.5厘米。心电图示:左房肥大,心肌缺血。空腹血糖26.04毫摩/升,酮体(-),尿糖(++++)。疱液检查:脓细胞0～2/低倍,糖9.63毫摩/升,蛋白35
Case Report Case 1: Female, 74 years old. History of diabetes for 15 years, usually no diet and unconscious hypoglycemic drugs. Since 1987, annual winter toes, heels and fingers repeatedly occur soybeans to jujube-size blisters, itching, more than 2 to 3 weeks of self-healing. February 6, 1989 due to palpitation and generalized edema admitted to hospital. Admission examination: blood pressure 23.9 / 12.8 kPa, apathetic, dyspnea. Body skin edema, cyanosis of the lips, jugular vein engorgement, lungs can be heard and wet rales Mu? 6 times / min, low heart sound blunt, can be heard and the fourth heart sound. On both sides of toe heel and fingers, left foot side, right forearm and auricle, etc. can be seen in the clear blisters of different sizes, blister wall tension, transparent, no swelling around. A large blister below the left lateral malleolus is about 7.0 cm × 6.5 cm. ECG shows: left atrial hypertrophy, myocardial ischemia. Fasting blood glucose 26.04 mmol / l, ketone body (-), urine sugar (++++). Blister fluid examination: pus 0 ~ 2 / low times, sugar 9.63 mmol / liter, protein 35