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患者,男,28岁,农民。既往体健。2个月前驾驶拖拉机,起动时方向盘猛击左前胸壁,随即意识丧失,数分钟后清醒,自感左胸痛,经当地医院检查,除胸壁轻度挫伤外,未见其它异常。半月后自觉活动后气短,并逐渐加重,不能平卧而来我院。查体:T37.2℃,P100,R28,Bp13/11kPa。半卧位,呼吸急促,胸壁无外伤痕迹,颈静脉怒张,两肺清晰,心界向两侧扩大,心尖搏动微弱,心律不整,早搏2～3次/分,心音低,心尖部闻及收缩中期喀喇音及2/6收缩期杂音,奇脉(+)。肝肋下3cm,剑下4cm,有压痛,双下肢轻度指凹性浮肿。心电图示Ⅰ、aVL呈QR波形,ST段轻度弓背向上抬高,T波倒置,V_4～V_6ST段呈水平型明显压低,T波双向,多次心电图动态观察无明显变化。住院期间曾发生多
Patient, male, 28 years old, farmer. Past physical health. Driving the tractor 2 months ago, the steering wheel punched the left anterior chest wall at start-up, then lost consciousness. After a few minutes, she awakened and left her chest pain. After examination by the local hospital, no other abnormalities were found except for mild contusion of the chest wall. Half a month after the conscious shortness of breath and gradually increased, can not lie down to our hospital. Physical examination: T37.2 ℃, P100, R28, Bp13 / 11kPa. Semi-recumbent, shortness of breath, chest wall without trauma, jugular vein engorgement, lungs clear, the heart to both sides of the expansion, weak apical beat, irregular heartbeat, premature beats 2 to 3 beats / min, low heart sound, Systolic midkick and 2/6 systolic murmur, odd pulse (+). Liver ribs 3cm, 4cm under the sword, tenderness, both lower extremity mildly concave edema. ECG showed Ⅰ, aVL QR waveform, ST segment mild bow back up, T wave inversion, V_4 ~ V_6ST segment was significantly lower horizontal, T wave bidirectional, multiple ECG showed no significant changes in dynamic observation. Occurred during hospitalization occurred