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患者孙××,女,30岁,住院号232141。孕妇因宫内孕第一胎37~(+5)周,先心病即马凡氏综合征,主动脉瓣换瓣术后两年多,于1986年1月31日入院。孕早期顺利,孕7个月有双下肢水肿休息后缓解,孕8个月发现血压高160/100mmHg,曾服复降片、地巴唑等药(药量不清),后血压降至正常。患者自幼瘦弱,身材较同年龄高大,善静,活动后有心悸、气短,并随年龄增长出现心前区痛。因症状逐年加重,曾于1983年11月在北京阜外医院行主动脉瓣换瓣术,术后服抗凝剂半年自觉无不适自行停药。既往史:1982年10月孕3~+月流产,1976年行子宫肌瘤剔除术。查体:T36℃,P80次/分,Bp110/70mmHg,R20次/分,体瘦无力型,神志清,能平卧,口唇、指趾端无紫绀,未见颈静脉怒张及颈动脉搏动,头部颜面瘦长,头顶尖,下腭突出,腭弓高,胸廓两侧不对称,左侧轻度塌陷,胸骨正中可见手术疤痕,两肺未见异常,心界向左扩大,心律齐,心率80次/分,胸骨左缘ⅡⅢ肋间可闻Ⅲ级收缩期杂音,二尖瓣区可闻Ⅲ级收缩期杂音,肝脾未触及,脊柱向右呈S形侧突,四肢细长,指(趾)瘦(长)尖伸展过度。胸片两肺纹理重,主动脉增宽,左室增大,超声心动图主动脉缩末、舒末均为60mm,左房左室大,主动脉换瓣术后瓣膜活动正常,未见血栓。产科情况:宫高30cm,腹
Patient Sun × ×, female, 30 years old, hospital number 232141. Pregnant women due to first trimester 37 ~ (+5) weeks of pregnancy, congenital heart disease that is Marfan syndrome, aortic valve flap more than two years after surgery, January 31, 1986 admission. First trimester of pregnancy, seven months pregnant with edema of the lower extremities rest after remission, 8 months pregnant found that high blood pressure 160 / 100mmHg, had taken diphenhydramine tablets, dipyrazole and other drugs (dosing unclear), blood pressure dropped to normal . The patient is emaciated, the body is older than the same age, and has good heart rate, heart palpitations and shortness of breath after exercise, and her anterior precordial pain appears with her age. Due to increased symptoms year by year, had in November 1983 in Beijing Fu Wai Hospital line aortic valve replacement surgery, postoperative anticoagulant six months without any discomfort involuntary withdrawal. Past history: October 1982 pregnant 3 ~ + abortion in 1976, myomectomy. Physical examination: T36 ℃, P80 beats / min, Bp110 / 70mmHg, R20 beats / min, the body is thin and weak, conscious, can be supine, lips, toes without cyanosis, no jugular vein distention and carotid artery pulsation , Head and face thin, head top, under the palate prominent, high palatal arch, chest asymmetry on both sides of the left slightly collapsed, Heart rate 80 beats / min, sternum left edge of Ⅱ Ⅲ intercostal can smell Ⅲ systolic murmur, mitral valve area can smell Ⅲ systolic murmur, liver and spleen not touched, the spine to the right was S-shaped process, limbs slender, Finger (toe) lean (long) tip extension. Chest X-ray weight of the lungs, aortic enlargement, left ventricular enlargement, echocardiography aortic end-systolic and end were 60mm, left atrial left ventricular large aortic valve replacement valve activity was normal, no thrombus . Obstetric conditions: Palace height 30cm, abdomen