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72岁男性患者,因1年来反复咳嗽和进行性呼吸困难于1990年入院。查体:两肺闻及哮鸣音,FEV_12.0L,FVC 3,2L,FEV_1与FVC 之比为63%.白细胞13600/mm~3,多核粒细胞81%,杆状白细胞11%。根据以上症状和检查,考虑为下列情况:①COPD 恶化;②可能为类似COPD 的胃食管反流;③多发性肺栓塞,因反复吸入的可能机制,难以解释症状和肺量测定的不符,而给予甲腈咪胺,灭吐灵试验性治疗.3天后,患者胸、臂、腿出现皮疹,为线形匐行性条纹,每日每时都有变化,但不痒.患者后来承认,1945年退役后不久出现过类似的皮疹,此后
A 72 year old male patient admitted to hospital in 1990 due to repeated coughs and progressive dyspnea over the past year. Examination: both lungs and wheeze, FEV_12.0L, FVC 3,2L, FEV_1 and FVC ratio of 63%. White blood cells 13600 / mm ~ 3, 81% of multicellular granulocytes, 11% of leukocytes. According to the above symptoms and examination, consider the following situations: ①OPD deterioration; ② may be similar to the gastroesophageal reflux disease COPD; ③ multiple pulmonary embolism due to repeated inhalation mechanism may be difficult to explain the symptoms and spirometry discrepancies, and given Cimetidine, metoclopramide experimental treatment .3 days after the patient chest, arm, legs rash, linear linear streaks, daily changes every hour, but itch. The patient later admitted to retire in 1945 A similar rash appeared shortly thereafter