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患者女,19岁。因“畏寒发热咳嗽3天”于1997年6月入院。无咯血及粉红色泡沫痰,无恶心、呕吐、心悸、关节疼痛及结节。查体:体温39.0℃,脉搏100次/分;扁桃体Ⅱ°大;左下肺呼吸音低;心腹无异常;肝脾不大。胸片:左下肺炎性改变。白细胞13.6×10~9/L(中性0.86)。诊断左下肺炎。予氧氟沙星抗炎,止咳,对症治疗一周,症状无缓解,觉活动后心累、气促、症状逐日加重并出现面色苍白,呼吸急促,夜间不能平卧,双下肢浮肿。查体见颈静脉充盈,肝颈征阳性。左肺第二肋以下叩浊,左肺及右下肺呼吸音消失,语颤减弱,右肺可闻及中细湿鸣。心界叩不清(左侧胸水),第一心音低钝,偶闻早搏,心率120次/分,心尖区闻及Ⅲ级吹风样收缩期杂音,向左腋下及左肩胛区传导,闻
Female patient, 19 years old. Because of “chills fever cough 3 days ” in June 1997 admitted. No hemoptysis and pink foam sputum, no nausea, vomiting, palpitations, joint pain and nodules. Physical examination: body temperature 39.0 ℃, pulse 100 beats / min; tonsil Ⅱ ° large; lower left lung breath sounds; no abnormal heart; liver and spleen not. Chest radiograph: Inflammatory changes in left lower lung. White blood cells 13.6 × 10 ~ 9 / L (neutral 0.86). Diagnosis of lower left pneumonia. To ofloxacin anti-inflammatory, cough, symptomatic treatment for a week, the symptoms did not ease, feel tired heart activity, shortness of breath, the symptoms increased day by day and pale, shortness of breath, night can not lie down, both lower extremity edema. Physical examination of the jugular vein filling, liver neck sign positive. Pulmonary peristalsis following the second rib, the left lung and right lower lung breath sounds disappear, weakened tremor, the right lung can smell and thin dampness. Heart knock knock (left pleural effusion), the first heart sound low blunt, smell premature beats, heart rate 120 beats / min, apex area smell and grade Ⅲ hair-style systolic murmur, left armpit and left shoulder blade conduction, smell