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1 病例报告 患者男性、78岁,因突发持续性胸闷、气短、大汗、恶心、呕吐于1999年12月17日入院。查体:血压21.3/17.3kPa、脉搏110次/分短绌,意识清晰,双侧瞳孔等大同圆,对光反射灵敏,双唇轻度发绀,双肺满布干性罗音,心界扩大,心率130次/分,心律不齐,心音强弱不等,肝脾未触及,双下肢无水肿。心电示:心房颤动,Ⅱ、Ⅲ 、avF异常Q波,V_2-V_5ST段明显抬高。诊断:急性前壁心肌梗死、陈旧性下壁心肌梗死、心房颤动(快速型)。给予吸氧、监护、降低心脏前后负荷及对症治疗,患者呼吸困难减轻。12月19日患者呼吸困难、口唇发绀加重,开始咳白色咆沫痰,不能平卧,四肢末梢发凉,血压下降至12/8kPa,双肺中下部可闻及水泡音。给予抬高床头、速尿、吗啡、西地兰静注,加快硝普钠滴速,患者呼吸困难
A case report Male patients, aged 78, were admitted to hospital on December 17, 1999 due to sudden and persistent chest distress, shortness of breath, sweating, nausea and vomiting. Physical examination: blood pressure 21.3 / 17.3kPa, pulse 110 beats / min dwarf, clear consciousness, bilateral pupils and other Datong circle, sensitive to light reflection, lips mild cyanosis, lungs covered with dry rales, expanding heart , Heart rate 130 beats / min, arrhythmia, heart sound intensity range, liver and spleen not touched, no lower extremity edema. ECG showed: atrial fibrillation, Ⅱ, Ⅲ, avF abnormal Q wave, V_2-V_5ST segment was significantly elevated. Diagnosis: acute anterior myocardial infarction, old inferior myocardial infarction, atrial fibrillation (rapid type). Given oxygen, monitoring, reduce the heart before and after the load and symptomatic treatment, patients with reduced breathing difficulties. December 19 patients with breathing difficulties, cyanotic lips increased, began to cough white rose Moutan, can not lie down, extremities cool, blood pressure dropped to 12 / 8kPa, the middle and lower lungs can be heard and blisters sound. Give elevated head, furosemide, morphine, cedilanid intravenous injection to speed up sodium nitroprusside drip, patients with dyspnea