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患者,男,46岁。因持续高热5天,腰痛、少尿、恶心1天,于1995年3月10日入院。既往体健。查体;T39.5℃,P104次/分,BP11/7kPa。神志清,颜面、颈部、胸部皮肤潮红,左上肢皮肤大片状瘀班,两球结膜充血,轻度水肿,咽部粘膜散在出血点,两肺散在干鸣音,心界不大,心率104次/分,律整,无杂音,腹稍膨隆,肝脾未及,双下肢无浮肿。实验室检查:白细胞29.1×10~9/L、中性0.84,血小板93×10~9/L,尿常规、蛋白(+++),BUN14mmol/L,ALT145U,免疫荧光抗体1∶160。胸片示;两肺纹理增多紊乱,沿肺纹理可见点片状密度增高影。入院时心电图:窦性心律,大致正常。诊断:流行性出血热,经抗感染、抗凝、扩容等综合治疗,体温正常,发热期为6天,低血压期2天,少尿期3天,多尿期10天。入院第3天出现胸闷、憋气、头昏,活动后明显,心率40～50次/分,下床时晕厥一次约10秒,即刻心电图示窦性心律,心率35次/分,结性逸搏,经阿托品激发试验证实为病窦综合征(SSS)。加用地塞米松10mg 1次/日静脉滴注,8天后心率增至60～65次/分,胸闷、头晕等症状消失,停用激素,继续静脉滴注能量合剂,住院25天痊愈出院。出院后随访半年,临床情况及心电图正常。 流行性出血热合并SSS的机理可能为病原体及其毒素使心肌发生非特异性炎症,如小灶性出血、
Patient, male, 46 years old. Due to sustained high fever 5 days, back pain, oliguria, nausea 1 day, March 10, 1995 admission. Past physical health. Examination; T39.5 ℃, P104 times / min, BP11 / 7kPa. Consciousness, face, neck, chest skin flushing, left upper limb skin flake large class, two ball conjunctival hyperemia, mild edema, pharyngeal mucosa scattered in the bleeding point, the lungs scattered in the dry beep, heart is not heart, heart rate 104 times / min, the whole law, no noise, slightly bulging belly, liver and spleen yet, no swelling of both lower extremities. Laboratory tests: white blood cells 29.1 × 10 ~ 9 / L, neutral 0.84, platelets 93 × 10 ~ 9 / L, urine, protein (+++), BUN14mmol / L, ALT145U, immunofluorescence antibody 1:160. Chest X-ray showed; increased lung disorder disorder, flaky density along the lungs can be seen increased shadow point. Admission ECG: sinus rhythm, roughly normal. Diagnosis: Epidemic hemorrhagic fever, anti-infective, anticoagulant, expansion and other comprehensive treatment, normal body temperature, fever for 6 days, 2 days hypotensive period, oliguria period 3 days, polyuria 10 days. Chest tightness, suffocation, dizziness, obvious after exercise, heart rate 40 ~ 50 beats / min, get out of bed when a syncope about 10 seconds, immediate ECG sinus rhythm, heart rate 35 beats / min, , Provoked by atropine test for sick sinus syndrome (SSS). Plus dexamethasone 10mg 1 / day intravenous drip, 8 days after the heart rate increased to 60 to 65 beats / min, chest tightness, dizziness and other symptoms disappear, stop using hormones, continue intravenous infusion of energy mixture, hospitalized 25 days cured. Follow-up after discharge for six months, the clinical situation and normal ECG. Epidemic hemorrhagic fever with SSS mechanism may be pathogenic pathogens and their toxin non-specific myocardial inflammation, such as focal hemorrhage,