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病例摘要患者张××印,男,29岁,軍人,河北省宝坻人。自1953年6月始,有間断性咳嗽,痰中带血絲,周身无力,不发烧等症状。于1954年12月住某医院接受吐根素(总量1.08克)、青霉素等治疗,症状未見好轉。当时检查两肺呼吸音粗糙,血压120/80毫米汞柱,X綫检查:右第三肋間有一直径約1厘米大小之阴影。痰浓縮检查:結核菌(-)、肺吸虫卵(-)。1955年1月4日始連續在痰中发現肺吸虫卵,乃确診为肺吸虫病。自3月8日开始氯喹啉治疗,每次0.25克,每日两次,共43日,共服20.5克。出院后,仍继續服用,每服20—30日,間隔一月,自1957年改为每日一次,直至1958年后始停药,約服250克,服药时間长达两年零10个月。患者服氯喹啉3—4个月后出現复視、怕光;1958年检查視野呈向心性縮小,症状逐漸加重。1960年8月因視力減退与夜盲而来我院就診。当时眼科检查:远視力:右0.4、左0.3;近視力两眼均为0.3,不能矫正。外眼未发现异常。两眼屈光間貭清晰,視神經乳头充血,視网膜血管无明显改变,有視网膜水肿,光反射增强并有皺褶,黄斑中心凹光反射可見。周围視野:右眼40°、左眼30°以內。1962年8月复診,視神經乳头呈淡黄色,視网膜周边部有灰白色渗出物与散在的点状色素斑块,中心凹光反射仍可見,但不清晰。1963年3月发現視网膜动脉呈一致性变细。整个視网膜呈青灰色,乳头黄斑間可見青銅色样斑点。血压正常。經耳鼻喉科及口腔科会診,未发現病灶。
Case Summary Zhang × × India, male, 29 years old, soldiers, Hebei Province, Baodi people. Since June 1953, intermittent cough, bloody sputum, whole body weakness, no fever and other symptoms. In December 1954 a hospital to accept ibuprofen (a total of 1.08 grams), penicillin and other treatment, the symptoms did not improve. At that time, two lungs were examined for rough breathing sounds, blood pressure 120/80 mmHg, X-ray examination: there was a shadow of a diameter of about 1 cm in the third intercostal space. Condensed sputum examination: Mycobacterium tuberculosis (-), paragonimiasis eggs (-). January 4, 1955 continuous onset of paragonimiasis in sputum eggs, is diagnosed as paragonimiasis. Chloroquinoline treatment since March 8, each 0.25 grams, twice daily, a total of 43 days, a total of 20.5 grams. After discharge from the hospital, they will continue taking 20-30 days per serving at intervals of January, changing from 1957 to once daily until after 1958, taking about 250 grams for about two years and 10 years Months. Patients with clopidogrel 3-4 months after diplopia, fear of light; 1958 examination showed a concentric reduction of vision, the symptoms gradually aggravated. August 1960 due to visual acuity and night blind come to our hospital. At that time ophthalmic examination: far vision: right 0.4, left 0.3; near vision of both eyes are 0.3, can not be corrected. Outer eye was not found abnormalities. Between the two eyes refraction 貭 clear, optic nerve nipple congestion, no significant changes in retinal blood vessels, retinal edema, enhanced light reflex and folds, foveal reflex visible. Around the field of vision: the right eye 40 °, 30 ° left eye. August 1962 referral, the optic nerve was pale yellow, peripheral retinal exudate and scattered scattered dot-like plaque, foveal reflex is still visible, but not clear. March 1963 retinal artery was found consistent thinning. The entire retina was blue-gray, bronze spots seen between the nipple macula. Normal blood pressure. Otolaryngology and dental consultation, no lesions were found.