论文部分内容阅读
患者女,59岁,主因阵发性胸闷、胸痛、气短3天入院。胸部闷痛持续时间较长1～5小时不等,并向双肩背部放射,伴大汗。查体:BP 14.7/10.7kPa,两肺呼吸音清,心界不大,心率84次/分,律齐,无杂音,心音低钝,A_2>P_2。ECG示:窦性心律,V_1～V_4呈病理性Q波,S—T抬高0.05～0.45mV,S—T Ⅱ、Ⅲ、avF水平压低0.1～0.3mV。入院后查心肌酶LDH1018U/L,AST 386U/L,CPK 1174U/L、CPK—MB 20U/L,α—HBDH 985U/L均明显高于正常。临床诊断:急性前壁心肌梗塞。给予吸氧、扩冠、抗凝、止痛、预防心律失常等治疗(因发病时间大于12小时,故未进行静脉溶栓治疗)。病情逐渐平稳。于入院后第3天晚突然出现言语不清,左侧肢体活动不利,当时查体:BP 16/10 kPa,神志清,言语不利,颈软,伸舌左偏,左侧肢体肌力“0”级,左侧巴氏征阳
Female patient, 59 years old, mainly due to paroxysmal chest tightness, chest pain, shortness of breath 3 days admission. Pain in the chest lasting a long duration of 1 to 5 hours, and back to the back of the radiation, with sweat. Examination: BP 14.7 / 10.7kPa, lung breath sounds clear, heart is not heart, heart rate 84 beats / min, law Qi, no noise, low heart sound blunt, A_2> P_2. ECG showed: sinus rhythm, V_1 ~ V_4 was pathological Q wave, S-T elevation of 0.05 ~ 0.45mV, S-T Ⅱ, Ⅲ, avF level depression 0.1 ~ 0.3mV. After admission, LDH1018U / L, AST 386U / L, CPK 1174U / L, CPK-MB 20U / L and α-HBDH 985U / L were significantly higher than normal. Clinical diagnosis: acute anterior myocardial infarction. Give oxygen, expansion of the crown, anticoagulation, pain relief, prevention of arrhythmia and other treatment (due to the onset of time greater than 12 hours, it is not for intravenous thrombolytic therapy). The condition gradually stabilized. On the third day after admission, his speech suddenly appeared unclear and his left limb was unfavorable. At that time, the physical examination was: BP 16/10 kPa, conscious mind, bad speech, neck softness, leftward deviation and left limb muscle strength "Level, the left side of the Paste positive