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患者,男,34岁,农民。右下肢被狗咬伤一周,未注射狂犬疫苗。突然胸闷、心慌、气急、流涎,吞咽困难,患肢麻木疼痛2天。出现畏光,怕风,狂躁不安,大声嚎叫一天,于1984年3月16日入院。 体检:体温36.5℃,呼吸26次;脉搏52次;血压110/70。神志清楚,恐水,畏光,怕风。口唇紫绀。双肺呼吸音粗糙,无罗音。心尖搏动于胸左第五肋间锁骨中线内1Cm,律不齐,可闻及期前收缩8～10次/min,各瓣膜区未闻及器质性杂音。腹软,肝脾未触及。脊柱四肢无畸形,右下肢腓肠肌处可见两个犬齿痕迹。神经系统检查(一):胸透:两肺纹理增粗。心电图示:窦性心动过缓,Ⅱ~0Ⅰ型及Ⅱ~0Ⅱ型窦房传导阻滞,多发室性早搏。 入院后立即O_2吸入,营养心肌,纠正心律失常,糖皮质激素等治疗。3h后,患者病情加重,经对症治疗
Patient, male, 34 years old, farmer. The right lower limb was bitten by a week dog, rabies vaccine is not injected. Sudden chest tightness, palpitation, shortness of breath, salivation, swallowing difficulties, limb numbness pain for 2 days. Photophobia, fear of the wind, manic anxiety, loud howling day, March 16, 1984 admission. Physical examination: body temperature 36.5 ℃, breathing 26 times; pulse 52 times; blood pressure 110/70. Conscious, fear of water, photophobia, fear of the wind. The lips are cyanotic. Breath sounds lungs rough, no rales. Apex beat in the chest left fifth intercostal midline clavicle 1Cm, irregular, can be heard and before the contraction of 8 to 10 beats / min, the valve area has not heard of organic murmur. Abdomen soft, liver and spleen not touched. Spinal limbs without deformity, right lower extremity gastrocnemius muscle visible at two canine marks. Nervous system examination (a): chest: a thicker lungs texture. ECG shows: sinus bradycardia, Ⅱ ~ 0 Ⅰ type and Ⅱ ~ 0 Ⅱ type sinoatrial block, multiple premature ventricular contractions. Immediately after admission O_2 inhalation, myocardial nutrition, correction of arrhythmia, glucocorticoid therapy. 3h, the patient aggravated, the symptomatic treatment