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患者,男,68岁.因劳力性胸闷气促两年伴下肢浮肿9个月入院.既往无肾病及高血压病史.体检:T36.4℃,P84次/分,R26次/分,BP15/10kPa,唇紫绀,颈静脉充盈.肺呼吸音增粗,右肺湿啰音较多.心界左下扩大,心音减弱,主动脉瓣区双期杂音.心尖区SMⅡ/Ⅵ级.下肢轻度浮肿,尿常规正常.血:Hb1115g/L,BUN6.8mmol/L,Cr110μmol/L.ECG:STv_（4～6）下垂型下移1～2mm,T波低平或倒置.X线胸片;双肺纹理增粗,右下肺有一片状阴影.心脏B超:左房左室增大,主动脉内径扩大,主动脉瓣增厚、狭窄并关闭不全,二尖瓣返流.临床诊断:冠心病、钙化性主动脉瓣狭窄并关闭不全.心衰Ⅲ°,右肺肺炎.入院后静脉给先锋霉素Ⅵ6g/d、口服长效硝酸甘油30mg/d、阿司匹林100mg/d、潘生丁75mg/d、卡托普利25mg/d.1周后卡托普利增量至150mg/d.用药第3周患者出现恶心厌食,尿量每日由1000ml左右减至300ml左右,气促浮肿加重.复查BP15/8kPa,蛋白尿(+),BUN39.78mmol/L,Cr461μmol/L.静脉即给利尿合剂及速尿20～80mg/d,经用4日无效后考
Patients, male, 68 years old. Due to labor chest tightness and shortness of breath for two years with lower extremity edema for 9 months before admission .No renal disease and history of hypertension in the past.Physical examination: T36.4 ℃, P84 beats / min, R26 beats / min, BP15 / 10kPa, cyanotic lips, filling the jugular vein. Pulmonary respiratory sound thickening, wet lung more right lung heart expanded lower left heart sounds aortic valve area double phase noise. , Urinary routine normal blood: Hb1115g / L, BUN6.8mmol / L, Cr110μmol / L.ECG: STv_ (4-6) drooping down 1 ~ 2mm, T wave low or inverted .X-ray; Lung texture thickening, the lower right lung has a shadow of the shadow of the heart B ultrasound: left atrial enlargement, aortic diameter, aortic valve thickening, stenosis and insufficiency, mitral regurgitation Clinical diagnosis: the crown Heart disease, calcification aortic stenosis and closed incomplete heart failure Ⅲ °, right lung pneumonia.After admission to the cephamirin Ⅵ 6g / d, oral long-acting nitroglycerin 30mg / d, aspirin 100mg / d, dipyridamole 75mg / d , Captopril 25mg / d Captopril increased to 150mg / d after 1 week.Niggating anorexia occurred in the third week of treatment, urine output decreased from about 1000ml to about 300ml per day, BP15 / 8kPa, protein (+), BUN39.78mmol / L, Cr461μmol / L. I.e. to IV furosemide diuretic agent and 20 ~ 80mg / d, by the use of invalid after the 4th test