IABP支持下紧急PICA成功治疗老人AMI并发心源性休克1例

患者，男，66岁。因发作性心前区压榨性疼痛10天。加重1小时入院。查体：体温37．2℃，脉搏70次／分，血压18．0/10.0kPa.呼吸18次/分。神志清楚，双肺呼吸音清晰，未闻及干湿罗音，心界无扩大，心率70次/分。律齐：腹平软，肝脾肋下未触及．双下肢无水肿。心电图示：Ⅱ．Ⅲ．avF导联ST段水平下降达0．15mV．心肌酶呈动态曲线增高(cK峰值748U/L，CK-MB峰值140U／L)。     

重症心肌炎1例讨论

患者，男性，23岁。因发热两天，伴咽痛、咳嗽、腹泻。l天来胸闷、气短、阵发性抽搐、意识丧失，被送到当地医院急诊。查体：血压：8／6干帕，心率40次／分，律齐，白细胞：13．09X109／升，中性粒细胞：0．80，淋巴细胞：0．20，胸透：左肺大片阴影，心电图：P波消失，结性心率，心室率40次／分。以肺炎、感染中毒性心肌炎、中毒性休克收入院。当时查体；血压：8／6千帕，神志清楚，精神弱，坐位，喘憋，肢体末梢紫绀，呼吸40次／分，双肺呼吸音粗，有散在于、湿性音，以左肺为甚，心界叩诊不大，心率：在40～120次／分之间，呈阵发性心动…     

电击伤引起扩张型心肌病1例

1 病例 患者，男，34岁，工人。被电击伤后出现胸闷、心悸一日人院。查体：T36．2℃，P100次／分，R26次／分，BP17．3／10．7KPa。意识清，颈静脉无怒张，双肺呼吸音正常，心率100次／分，心律不齐，可闻及早搏6～8次／分，各瓣膜听诊区未闻及病理性杂音，腹软，无压痛，肝脾未触及，双下肢无浮肿。神经系统检查未见异常。心电图示：窦性心律，室性早搏。     

心律平静注终止室上速致窦性静止3例

例1 女,72岁。过劳后突发心慌、头晕2小时急诊就医。既征无心动过速发作史。查体:意识清,呼吸平稳,血压17/10kPa(128/75mmHg),心率170～174次/分,律齐,无杂音,双肺听诊正常,心电图示室上性心动过速。在心电监护下,心律平70mg加10％葡萄糖10ml静注5分钟,用药过程中心室率逐渐变慢,当心率127次/分时,室上速终止,出现窦性静止长达5秒钟,患者突然阿-斯发作,即刻心前区按压,渐恢复窦性心律,心率60～65次/分,患者感觉良好。追问病史,平素心率60～65次/分,无冠心病、高血压病史,但心电图胸导联T波普遍低平,彩色多普勒超声心动图检查未见异常。后行心内电生理检查示房室结双径路,射频消融治疗成功。     

西咪替丁致窦性心动过缓3例

例1:男,30岁。因十二指肠多发性溃疡住院,入院体查:体温37℃,呼吸26次/分,血压14/8千帕,心率76次/分,律齐,心音有力,心脏听诊无杂音。心电图示:窦性心律,正常心电图。予西咪替丁0.2克,3次/日,每晚0.4克,以及硫糖铝1克,4次/日治疗。1周后出现心悸,心脏听诊心率53次/分,即行心电图检查诊断为窦性心动过缓并不齐,心率51次/分。     

经食道超声心动图诊断左心耳黏液瘤1例

<正>病例女，74岁，因“两天前夜间突发胸闷、心悸”入院。既往有高血压病史8年余；否认冠心病等慢性病病史，否认肝炎、结核等传染病病史。体格检查：体温36.3℃，心率66次/分，呼吸18次/分，血压117/72 mmHg(1 mmHg≈0.133 kPa)，双肺呼吸音清，未闻及干湿性啰音，心界无扩大，心音有力，各瓣膜听诊区未闻及病理性杂音。     

急诊介入栓塞术抢救肝破裂修被术后再出血成功1例

病例 男，40岁，以“腹部摔伤腹痛3h”入院，T36.4℃、心率84次/分，呼吸21次/分，血压18/11kPa患者神志清，精神及饮食差，无黄疸，无发势，腹部平坦，左右对称，腹式呼吸存在，无腹壁静脉曲张及胃肠病动波，右上腹肌紧张，有压痛，无反跳痛，莫菲征阴性，全腹未触及包块，脾区扣痛阴性，肝区扣痛阳性，双肾区扣痛阴性，腹部扣诊无移动性浊音，肠鸣音减弱，约3次/分，未闻及气过水声，彩超示：肝内血肿，少量血腹。     

婴儿维生素B_1缺乏症二例

［例1］男，3个月。因发热、咳嗽3天，气促、面色苍白1天入院，病儿系纯母乳喂养。体检：体温382℃，脉搏168次／分，呼吸65次／分，体重5．6kg。面色苍白，呼吸急促，鼻翼扇动无发绀.双肺呼吸音粗，无罗音。心音稍低钝，各瓣膜区无杂音。腹稍胀，肝右肋下1cm，肌张力稍低，神经系统检查无异常。血白细胞11×109／L，中性粒细胞0．52，淋巴细胞0．48。X线胸片示肺炎、心影稍大。心电图示T波低平、QT间期延长。入院诊断：支气管肺炎并心衰。予抗感染、抗病毒、补液、吸氧，对症及支持等治疗后病情恶化，心率200次／分，呼吸84次／分，双肺…     

临床常见诊疗错误汇编（264）——颈痛非颈病 缘自放射痛——1例急性心肌梗死误诊为颈椎病的教训

患者，男，65岁。因颈后部疼痛2小时来我院就诊。患者在晨起活动中突然感到颈后部疼痛，无放射性痛，伴面色灰白、大汗淋漓。体格检查：脉搏72次／分，血压17／10kPa。痛苦面容，神志清晰，口唇无紫绀。双肺呼吸音正常，心率72次／分，心律整齐，未闻及杂音。颈4～5椎体处压痛明显。心电图示大致正常心电图。拟诊为颈椎病，     

颅内肿瘤误诊为病毒性心肌炎2例分析

1病例介绍【例1】患儿男，4岁零9月，因头昏乏力10余天，心动过缓收入院。病后有间断性非喷射状呕吐，伴精神萎靡、纳差、乏力。查体：体温、呼吸正常，脉搏64次／分，消瘦，精神极度萎靡，易激惹，哭声弱，咽红，扁桃体1度大，双肺呼吸音清晰，心率64次／分，律齐，心音低钝，腹软，肝脾未扪及，颈阻阴性，克氏征、布氏征阴性，未引出病理反射。入院后心电图示心律55次／分，窦性心动过缓伴不齐，轻度心肌缺血。血沉、抗“O”正常，心肌酶谱正常，血清钾、钠、氯、钙均正常。入院后按病毒性心肌炎静滴维生素C、肌苦等治疗，心率55～70次／…     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.     

Observations with Rabenid in patients with locomotor disease

By examining 139 patients suffering from locomotor diseases the author could observe the characteristic accompanying diseases as well as high uric acid level in 40 cases. She analyses the current opinions on hyperuricaemia and reports on her observations with uricosuric and antithrombotic coated Rabenid tablet (RG). She found sulfinpyrazone to be effective and valuable in the examined indication field.     

Changes in myocardial function in patients with hypertension during treatment with minipress

Altogether 33 patients with arterial hypertension were investigated to study changes of left ventricular systolic phasic analysis, caused by prazosin therapy. Two groups were identified on the basis of these changes: indices in the 1st group (intrasystolic index, myocardial tension index, Blumberger coefficient) improved, in the 2nd group they deteriorated. The antihypertensive effect of prazosin should be assessed not only by the level of BP reduction but also by changes of left ventricular systolic phasic analysis. In the deterioration of indices of left ventricular systolic phasic analysis during a test with single administration of prazosin, antihypertensive therapy should be reconsidered.