论文部分内容阅读
患者男性,19岁,农民,住院号187094。因劳累后心悸气短胸闷1年,近2月伴口唇紫钳于1987年3月入院。患者1年前在劳动时感心悸胸闷,常有阵发性剧烈咳嗽。2个月前因盖房劳动中突然胸闷气短伴前胸疼痛,口唇发紫,不能平卧呈端坐呼吸,阵发性咳嗽。即去当地医院检查,拟诊为风湿性心脏病二尖瓣狭窄。经治疗后不见好转,随经超声心动图检查才证实为右心多发性肿瘤转入我院.休征:全身情况欠佳,口唇紫钳,不能平卧。心率100次/分,心律齐。胸骨左缘2一4肋闻Ⅱ～Ⅲ级收缩期杂音,P_2↑有分裂。心尖部闻及Ⅱ级收缩期杂音,三尖瓣区Ⅱ级舒张期杂音,杂音与体位均无关系。肝肋下1.5cm,剑突下3.0cm。两下肢有轻度凹陷性水肿。X线片示二肺血量明显减少,右房右室增大明显。心电图提示窦性心律,右心房肥大,右心室肥大,ST-T改变。超声心动图:二维超声心动图长轴示主动脉、左房左室回声正常。扩大的右室充满中度回声反射团块,短轴可见中度回声。肿瘤在收缩期与舒张期均通过三尖瓣口伸至扩大的右房及收缩期向上通过肺动脉瓣口伸至肺动脉主干内。心脏四腔观可见中度
Patient male, 19 years old, farmer, hospital number 187094. Due to tiredness, shortness of breath and chest tightness for 1 year, nearly 2 months with purple lips and pliers was admitted to hospital in March 1987. The patient feels chest tightness at work one year ago and often has frequent paroxysmal coughing. 2 months ago due to the sudden chest tightness and shortness of breath during the building labor with chest pain, purple lips, can not lie supine breathing, paroxysmal cough. That is to go to the local hospital for examination and be diagnosed with rheumatic heart disease mitral stenosis. After treatment was not improved, with echocardiography examination confirmed that the right heart multiple tumors were transferred to our hospital. Hugh levy: poor general condition, lip purple pliers, can not lie. Heart rate 100 beats per minute, heart rate equal. The left sternal border of the 2 to 4 ribs heard II ~ III systolic murmur, P 2 ↑ split. Apex systolic murmurs were heard in the apex, and diastolic murmurs in the tricuspid region were not related to murmurs and posture. The liver is 1.5 cm below the ribs and 3.0 cm below the xiphoid process. Both sides have mild depression edema. The X-ray showed that the amount of blood in the second lung was significantly reduced, and the right atrium increased significantly in the right ventricle. The electrocardiogram suggested sinus rhythm, right atrial hypertrophy, right ventricular hypertrophy, and ST-T changes. Echocardiography: The long axis of a two-dimensional echocardiogram shows normal aortic and left atrial left ventricle echo. The enlarged right ventricle is filled with moderately echogenic clumps and the short axis shows moderate echoes. Both the systolic and diastolic phases of the tumor extend from the tricuspid valve opening to the enlarged right atrium and systolic upward through the pulmonary valve opening into the main pulmonary artery. Four-chamber view of the heart can be seen moderate