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原发性血小板减少性紫瘢(ITP)出血部位多见于皮肤、牙龈、鼻粘膜、结膜下、泌尿系、胃肠道等,发生心包出血引起心包填塞者罕见,我们曾遇1例,现报告如下.患者,女,53岁.间断牙龈出血、皮肤淤点1年,未治疗.3月前症状加重,就诊于当地医院应用激素、止血药等治疗2月余好转出院.之后停服所有药物.半月前出现心悸、胸闷并进行性加重,不能平卧而入院、体检:T36.5℃,P120次/分,BP12/0kPa.半卧位,神志清,全身皮肤见散在淤斑及陈旧性出血点.全身浅表淋巴结无肿大.牙龈及合体出血.颈静脉怒张.胸骨无压痛.左肺呼吸音低.心尖搏动未触及.心浊音界向两侧扩大.心率120次/分,律齐,心音遥远.肝肋下2cm,脾未触及,肝颈征(+).腹部无移动性浊音.双下肢轻度指凹性浮肿.神经系统无异常体征.实验室检查:血红蛋白96g/L,白细胞6.4×10~9/L,血小板34×10~9/L;尿常规(一);大便潜血(+);出血时间2分,凝血时间(试管法)19分;凝血酶元时间20秒/16秒(对照).3P试验(-);胸片示心脏呈普大型,心胸比率0.73;心脏彩超示心脏周围大量液性暗区,心尖部5.0cm;胸部CT未见异常.入院当时因
Primary thrombocytopenic purpura (ITP) bleeding sites more common in the skin, gums, nasal mucosa, subconjunctival, urinary tract, gastrointestinal tract, pericardial bleeding caused by pericardial embolism are rare, we have encountered one case, the report is now The patient, female, aged 53. Discontinuous gingival bleeding, skin petechia for 1 year, untreated .At 3 months ago, the symptoms worsened, visited the local hospital for treatment of hormones, hemostatic drugs and other treatment more than 2 months out of hospital .After stopping all the drugs Half a month before the heart palpitations, chest tightness and progressive increase, not supine and admission, physical examination: T36.5 ℃, P120 beats / min, BP12 / 0kPa. Semi-recumbent, clear mind, systemic skin scattered in ecchymosis and obsolescence Bleeding point. Systemic superficial lymph nodes without swelling. Gums and bleeding. Jugular vein distention. Sternal no tenderness. Left lung breath sounds low. Apex beat not touched. Law Qi, distant heart sounds. Liver ribs 2cm, spleen not touched, liver neck sign (+). Abdominal no movement of dull .Symptoms of both lower extremity mildly concave edema .Nervous systemNo abnormal signs .Laboratory examination: hemoglobin 96g / L, white blood cells 6.4 × 10 ~ 9 / L, platelets 34 × 10 ~ 9 / L; urine routine (a); fecal occult blood 2 points, clotting time (test tube method) 19 points; Thrombin time 20 seconds / 16 seconds (control) .3 P test (-); chest X-ray showed a large heart, cardiothoracic ratio 0.73; Sexual dark area, apical 5.0cm; chest CT no abnormalities