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患者 男、41岁、工人.92年月4月13日突然右上腹持续性剧痛8小时.病人无心前区疼.门诊以急性胰腺炎收入普外治疗.查体:BP16/11.8kpa、T37.2℃。发育好,语畅.呼吸促。两肺(-).心界不大,律齐,率135次/分,S_1略弱.腹软,左上明显触痛.无肌卫及反跳痛.移动浊音(一).化验:WBC14.0×10~9/L,sg93％;血淀粉酶21.76MKaT/L(0～2.66);尿淀粉酶10.83Mkat/L(0. 67～10. 66);肝肾功能正常。心肌酶学明显增高: AST2. 16Mkat/L(1.67);ck-NAC4.24Mkat/L(0.42～3. 17);α-HBD7.05Mkat/L(0.87～3.07);LDH6.55Mkat/L(1.90～4.13).B超:胰腺增大,回声低,表面起伏不平,符合急性胰腺炎.心电图:下壁Ⅱ、Ⅲ avF,正后壁 V_(7.8.9)及 V_6右室 V3R. 4R.5R.6R.ST段呈损伤性弓背抬高;并出现病病理性Q波.系列心电图符合急性心梗演变规律,经禁食、青霉素静滴、解痉、尿激酶溶栓、消心痛扩冠镇痛、极化镁液改善心肌代谢,23天酶学正常出院。
Patient male, 41 years old, worker 92 years April 13, suddenly right upper quadrant pain sustained 8 hours .Patients with no pain in front of the heart.Patients with acute pancreatitis income general treatment. Physical examination: BP16 / 11.8kpa, T37 .2 ° C. Good development, language smooth. Two lungs (-). Heart, Law Qi, the rate of 135 beats / min, S_1 slightly weaker. Soft abdomen, the left upper clear tenderness. No muscle and rebound tenderness. 0 × 10 ~ 9 / L, sg93%; blood amylase 21.76MKaT / L (0 ~ 2.66); urinary amylase 10.83Mkat / L (0.67 ~ 10.66); liver and kidney function was normal. Myocardial enzymology was significantly higher: AST2.16Mkat / L (1.67); ck-NAC4.24Mkat / L (0.42-3.17); α-HBD7.05Mkat / L (0.87-3.07); LDH6.55Mkat / L ~ 4.13) .B ultrasound: pancreatic enlargement, low echo, uneven surface, in line with acute pancreatitis.Electrocardiogram: lower wall Ⅱ, Ⅲ avF, positive posterior wall V_ (7.8.9) and V_6 right ventricle V3R. 4R.5R .6R.ST segment was injured dorsal rachis elevated and pathological Q wave appeared.Series ECG consistent with the evolution of acute myocardial infarction, fasting, penicillin intravenous infusion, antispasmodic, urokinase thrombolysis, diastolic heart crown Analgesia, magnesium solution to improve myocardial metabolism, 23 days normal discharge of enzyme.