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患者 男性,75岁,退休工人。主因咳嗽、咯痰、痰中带血两个月伴右胸痛、气喘1周入院。既往:癫痫史45年。查体:T36.8℃,P120次/分,R25次/分,BP20/14kPa(150/105mmHg),慢性病容,呼吸急能平卧,口唇轻度发绀,全身浅淋巴结不肿大。右胸叩浊,呼吸音低,双肺多量干湿啰音,以左肺甚;心率120次/分。腹软,肝肋下1cm,质软,脾未触及。双下肢指凹性水肿Ⅰ度。血常规:Hb120g/L,WBC5.5×10~9/L,N0.66,L0.34。心电图示窦速。胸大片示:右胸腔大量积液,左下肺不规则团块状阴影。初诊印象:右侧胸腔积液、左肺癌、冠心病。给予抗感染、抗痨及冠心病常规治疗。住院期间查:血沉36mm/h;胸CT示:右胸腔积液、左肺下叶前基底段不张伴左肺下叶炎症,考虑肺癌。痰找结核菌阴性,痰培养为弗劳地枸橼酸杆菌,痰发现可疑癌细胞。第一次胸穿,
Male patient, 75 years old, retired worker. Mainly due to cough, expectoration, bloody sputum with right chest pain for two months, 1 week admitted to asthma. Past: history of epilepsy 45 years. Examination: T36.8 ℃, P120 beats / min, R25 beats / min, BP20 / 14kPa (150 / 105mmHg), chronic disease, respiratory supine, mild lip lips, systemic superficial lymph nodes is not enlarged. The right chest knock turbid, low breath sounds, wet and dry lungs a large number of voices to the left lung; heart rate 120 beats / min. Abdomen soft, liver ribs 1cm, soft, spleen not touched. Lower extremity refers to the degree of concave edema. Blood: Hb120g / L, WBC5.5 × 10 ~ 9 / L, N0.66, L0.34. ECG shows sinus speed. Chest large show: a large number of right pleural effusion, left lower lobe irregular mass-like shadow. Initial impression: right pleural effusion, left lung cancer, coronary heart disease. Give anti-infection, anti-tuberculosis and coronary heart disease routine treatment. Check during hospitalization: ESR 36mm / h; chest CT showed: right pleural effusion, left anterior lobe of the anterior basement membrane with left anterior lobe inflammation, consider lung cancer. Negative sputum to find tuberculosis, phlegm culture to Citronella bacteria, sputum found suspicious cancer cells. First chest wear,