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患者,女,35岁。因劳累性心悸、胸闷、气短5年,腹胀半年,于1992年7月1日收住本院。入院前长期口服地高辛(每次0.25mg,每日1次)、双氢克尿噻(每次25mg,每日1次),休息状态下无不适感。查体:(?)瓣面容,巩膜轻度黄染,颈静脉怒张,双肺呼吸音粗糙。心界向左下扩大,心率92次/min,心音强弱不等,心律绝对不齐,心尖部可闻及双期杂音。腹部膨隆,肝脏肋下4.0cm,质硬,腹水征阳性,双下肢轻度可凹性浮肿,心电图示异位心律、心房纤颤。超声心动图示左房、左室、右室及右房流出道扩大,二尖瓣呈城墙垛样改变。胸部X线片示双肺纹理粗乱,心脏呈普大型。血常规示白细胞9.2×10~9/L,血沉20mm/h;血钾4.6mmol/L。肝功能示总胆红质21.4μmol/L,麝香草酚浊度试验Zu,谷丙转氨酶<40μ。诊断:(1)风湿性心脏病(二尖瓣狭窄并关闭不全),(2)心功能衰竭Ⅱ°,(3)心源性肝硬化。入
Patient, female, 35 years old. Due to fatigue palpitations, chest tightness, shortness of breath for 5 years, bloating for six months, on July 1, 1992 admitted to the hospital. Long-term oral administration of digoxin before admission (each 0.25mg, 1 day), hydrochlorothiazide (25mg, 1 time per day), rest without discomfort. Check body: (?) Valve surface, scleral mild yellow dye, jugular vein engorgement, lungs rough breathing sounds. Heart to expand to the left, heart rate 92 times / min, heart sound intensity range, heart rate is absolutely missing, apex can be heard and double noise. Abdominal bulge, liver ribs 4.0cm, hard, positive signs of ascites, both lower extremity mild concave edema, ECG ectopic heart rhythm, atrial fibrillation. Echocardiography showed left atrium, left ventricle, right ventricle and right atrial outflow tract expansion, mitral wall was like the city change. Chest X-ray showed double lung texture disorder, the heart was large. Blood showed normal white blood cells 9.2 × 10 ~ 9 / L, erythrocyte sedimentation rate 20mm / h; serum potassium 4.6mmol / L. Liver function showed total bilirubin 21.4μmol / L, Thymosin turbidity test Zu, alanine aminotransferase <40μ. Diagnosis: (1) rheumatic heart disease (mitral stenosis and insufficiency), (2) heart failure Ⅱ °, (3) cardiogenic cirrhosis. Into