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1 病例摘要例1:患者女性,51岁,于1988年5月6日以双眼睑与下肢间歇性浮肿7～8年,胸闷心悸4月入院。患者4个月来曾多次在基层医院就诊,诊为结核性心包炎,伴大量心包积液,并接受正规抗痨治疗5个月,因症状逐日加重,而转来本院。检查:T37℃,血压20/12kPa,甲状腺无肿大,颈静脉稍充盈,轻度贫血貌,两肺听诊阴性,心界向两侧扩大,心率86,律齐,心音低钝,未闻及病理性杂音,颜面及下肢无浮肿。总胆固醇6.17mmol/L,甘油三脂2.17mmol/L,肌酐70.7μmol/L,尿素氮5.8mmol/L。心电图示窦性心律,低电压。超声心动图提示:心室肌间隔肥厚,心包腔积液900～1000ml,诊断为肥厚性心肌病,大量心包积液。入院后用糖皮质激素及抗痨药物治疗近2月,并先后抽心包积液4次,共计1660ml,但积液仍继续增加。检查心包液为漏
1 Case Summary Example 1: Female patient, 51 years old, with eyelid and lower extremity edema intermittently on May 6, 1988, for 7-8 years. Chest tightness and palpitation were admitted in April. Patients in the primary hospital for four months to many times for treatment, diagnosed with tuberculous pericarditis, with a large number of pericardial effusion, and received formal anti-tuberculosis treatment for 5 months, due to the symptoms increased day by day, and transferred to our hospital. Check: T37 ℃, blood pressure 20 / 12kPa, no thyroid enlargement, a slight filling of the jugular vein, mild anemia, lung auscultation negative, heart to both sides to expand, heart rate 86, law Qi, heart sound low blunt, not heard Pathological murmur, facial and lower extremity no edema. Total cholesterol 6.17mmol / L, triglyceride 2.17mmol / L, creatinine 70.7μmol / L, urea nitrogen 5.8mmol / L. ECG shows sinus rhythm, low voltage. Echocardiography Tip: Ventricular muscle hypertrophy, pericardial effusion 900 ~ 1000ml, diagnosed with hypertrophic cardiomyopathy, a lot of pericardial effusion. After admission with glucocorticoid and anti-tuberculosis drugs for nearly 2 months, and has pumping heart fluid 4 times, a total of 1660ml, but the fluid continues to increase. Check the pericardial fluid is leaked