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患者女,43岁,农民。因咳嗽、咳痰、气紧40天,呼吸困难3天于1994年2月20日入院。入院前3天,患者服中药50ml后呛咳,呼吸困难,外院按“肺炎、呼衰”抢救后有好转。既往无吞咽不畅,纳差及慢性咳嗽史。入院查体:T36℃,p120次/分,R34次/分,BP15/10kPa。端坐呼吸,口唇轻度发绀,气管略右偏,无颈静脉怒张,双肺遍布哮鸣及中细湿鸣,心界无扩大,心率120次/分,律齐无杂音。腹部及神经系统无异。实验室检查:血常规WBC15.1×10~9/L,N0.94,L0.06,Hb11.7g,PC263,SR57mmHz/20′。心电图示窦速。胸部正位片示上纵膈右侧有一向外突出的弧形影,边缘光整,内缘明显压迫气管,使气管狭窄移位。右侧位片示上述块影位于后纵膈,亦有气管明显受压征象。拟诊为纵膈肿瘤、肺癌待排。入院后予以抗炎、吸氧及综合治疗,呼吸困难缓解,进食少量流质及服西药无明显不适。胸外科会诊者虑纵膈肿瘤。入院后第6天因进食流质40ml后出现呛咳及极度呼吸困难、烦燥,查体双肺干湿鸣,心率150次/分,心音低钝,经吸氧、解痉、利尿救治后
Patient female, 43 years old, farmer. Due to coughing, coughing, and tightness for 40 days, dyspnea was admitted to hospital on February 20, 1994 for three days. 3 days before admission, the patients taking traditional Chinese medicine 50ml cough, difficulty breathing, hospital press “pneumonia, respiratory failure” after the rescue had improved. No previous dysphagia, anorexia and chronic cough history. Admission examination: T36°C, p120 beats/minute, R34 beats/minute, BP15/10kPa. Sitting breathing, lips slightly cyanotic, slightly right side of the trachea, no jugular vein engorgement, lungs wheezing in the middle and fine mesmerizing, no expansion of heart, heart rate 120 beats / min, no noise. The abdomen and nervous system are no different. Laboratory tests: blood WBC15.1 × 10 ~ 9 / L, N0.94, L0.06, Hb11.7g, PC263, SR57mmHz / 20 ’. ECG shows sinus speed. Chest anteroposterior shown on the right side of the mediastinum has an outwardly protruding curved shadow, edge finishing, the inner edge of the apparent compression of the trachea, tracheal stenosis so displaced. The right side panel shows that the block shadow is located in the posterior mediastinum, and there are also signs of significant pressure on the trachea. It is expected to be diagnosed as mediastinal tumor and lung cancer. After admission to be anti-inflammatory, oxygen and comprehensive treatment, ease breathing difficulties, eating a small amount of liquid and taking medicine no obvious discomfort. Thoracic surgeons consider mediastinal tumors. On the 6th day after admission, due to eating fluid 40ml, there was cough and extreme dyspnea, irritable dryness, dry lungs and wet sound of the lungs, heart rate 150 beats per minute, low heart sound blunt, after oxygen absorption, spasm, diuretic treatment