论文部分内容阅读
患者,女,45岁。因刺激性干咳4月,心慌、气促、胸痛、上行性水肿2月,在外院诊断为“心包炎”,心包穿刺抽出少许黄色液体,经抗炎,利尿治疗半月,水肿消退,但心包积液无减少而转我院。体查:体温36.4℃,血压13/11kPa,半卧位,全身浅表淋巴结未扪及,颈静脉充盈,左胸廓饱满,右下肺呼吸音偏低,心尖搏动消失,心浊音界向双侧扩大,心率96次,律齐,无杂音,心音遥远,肝肋下2cm,肝颈返流征+,可触及奇脉。实验室检查:血常规基本正常。尿常规,尿素氮,肝功能,血沉,抗“O”均正常。EKG:窦性心律,肢导联低电压。B超:肝大;心包大量积液。胸透及胸片:两肺未见实变影,心包大量积液。入院后,给予抗痨治疗,并作心包穿刺,抽出血性心包积掖500ml,送检示渗出液,未见癌细胞。
Patient, female, 45 years old. Due to irritating dry cough in April, palpitation, shortness of breath, chest pain, ascending edema in February, diagnosed in the external hospital as “pericarditis”, pericardial puncture to extract a little yellow liquid, after anti-inflammatory, diuretic treatment for half a month, edema subsided, but the pericardial The fluid was transferred to our hospital without reduction. Physical examination: body temperature 36.4°C, blood pressure 13/11kPa, semi-supine, no superficial lymph node metastasis, jugular vein filling, left thorax full, right lower lung breath sounds low, apical pulse disappeared, heart voiced boundary to both sides Expanded, heart rate 96 times, law, no noise, heart sounds far away, 2cm below liver ribs, sign of liver regurgitation, can touch the odd pulse. Laboratory tests: The blood is basically normal. Urine routine, urea nitrogen, liver function, erythrocyte sedimentation rate, anti-O were all normal. EKG: Sinus rhythm, low voltage in limb leads. Ultrasound: Liver; pericardial effusion. Chest and chest X-rays: There was no real change in both lungs and a large pericardial effusion. After admission, he was given antituberculosis treatment and pericardial puncture. Hemorrhagic pericardial effusion was collected and 500ml was delivered. The exudate was sent for examination and no cancerous cells were found.