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患者,男性,57岁,住院号:901021。因胸闷、心前区绞痛拟急性心肌梗塞于1990年4月23日入院。入院后行心电监护。心电图示:急性广泛前壁、右室心肌梗塞并Ⅲ°房室传导阻滞,体检除心率较慢(50次/分),心音低钝外,余无特殊异常发现.化验:白细胞11800/mm~3,中性分叶粒细胞79%,淋巴细胞21%,血沉22 mm/小时,SGOT450u。按急性心肌梗塞给予心电监护及治疗两周,病情稳定。在发病的第19天开始发热,体温在37.8～39.2℃。并感心前区疼痛,于深呼吸时加剧,咳嗽伴血性痰,不敢活动,大汗淋漓。体检:双肺水泡音,心前区闻及心包摩擦音。心电图未见再梗塞之改变。复查血白细胞16000/mm~3,中性粒细胞88%淋巴细胞12%,血沉60mm/第一小时。X线片见双肺中下野有炎症改变,超声波示心包及左侧胸腔有少许积液。予以大剂量抗生素(氨基苄青霉素)治疗三天未见好转,考
Patient, male, 57 years old, hospital number 901021. Due to chest tightness, anterior myocardial infarction in patients with acute myocardial infarction in April 23, 1990 admission. After admission, ECG monitoring. ECG: acute extensive anterior wall, right ventricular myocardial infarction and Ⅲ ° atrioventricular block, physical examination in addition to heart rate slower (50 beats / min), low heart sound outside the bluff, I found no special abnormalities. Leukocytes 11800 / mm ~ 3, 79% of neutral leaf cells, 21% of lymphocytes, erythrocyte sedimentation rate 22 mm / h, SGOT450u. According to acute myocardial infarction given ECG monitoring and treatment for two weeks, his condition was stable. Fever started on the 19th day of onset with body temperature ranging from 37.8 to 39.2 ° C. And feel the pain in the anterior region, exacerbated in deep breathing, cough with bloody sputum, afraid to activity, sweating. Physical examination: lungs blisters sound, precordial area and pericardial friction sound. ECG no longer change the infarct. Review of white blood cells 16000 / mm ~ 3, 12% of neutrophils 88% lymphocytes, ESR 60mm / first hour. X-ray see the lungs have inflammation of the middle and lower back, ultrasound showed pericardial and left pleural effusion. To high doses of antibiotics (aminobenzyl penicillin) did not improve the treatment for three days, test