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病史摘要杨某,男,6个月。因发热、咳嗽、气喘10余天,咳喘加剧2天于1986年3月24日入院。当地曾用过青霉素、红霉素疗效不佳。平素经常呈不规则发热、气喘。G_1P_1,生后混合喂养,否认结核病接触史。父母非近亲婚配。其母在孕期体健,亦无服药史。入院时体检:T36.4℃,R60次,P120次,神清,面色苍白,鼻翼搧动,口唇青紫。心前区隆起,心浊音界在左乳线外1cm。胸骨左缘第3～4肋间闻及Ⅲ～Ⅳ级收缩期杂音,性质粗糙,伴有收缩期震颤。两肺可闻及广泛哮鸣声及湿性罗音。脐部隆起,直径4.5cm,可还纳。肝肋下2.5cm,质尚软。脾未扪及。外生殖器及四肢无畸形。血红蛋白100g/L,白细胞6.7×10~9/L,N47％,L48％,M5％;胸片示:两肺纹理增加伴有片状阴影,肺动脉段突出,心缘饱满,心影横径增大,左膈抬高,界限不清(见图1)。血钾4.4
Summary of medical history Yang, male, 6 months. Due to fever, cough, asthma more than 10 days, cough exacerbated 2 days in March 24, 1986 admission. Local penicillin used, erythromycin ineffective. Often irregular irregular fever, asthma. G_1P_1, mixed feeding after birth, denied a history of exposure to TB. Parents non-relatives marriage. His mother’s body during pregnancy, nor medication history. Physical examination on admission: T36.4 ℃, R60 times, P120 times, Shen Qing, pale, nose flap, lips bruising. Prefrontal bulge, heart dull circles in the left breast line 1cm. Sternal left margin of the 3rd ~ 4 intercostal smell and Ⅲ ~ Ⅳ systolic murmur, rough nature, accompanied by systolic tremor. Two lungs can be heard and a wide range of wheezing and wet rales. Umbilical uplift, diameter 4.5cm, but also satisfied. Liver ribs 2.5cm, the quality is still soft. Spleen not palpable. External genital and limbs without deformity. Hemoglobin 100g / L, white blood cells 6.7 × 10 ~ 9 / L, N47%, L48%, M5%; chest X-ray showed increased lungs associated with flaky shadows, pulmonary artery prominent, Large, left diaphragm elevation, ill-defined (see Figure 1). Potassium potassium 4.4