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慢性肾功能衰竭尿毒症期,由于多器官受累,而往往以其它系统症状起病而造成误诊。近来我科曾遇1例以心脏症状起病而误诊为扩张型心肌病,现报告如下。 华某,男,54岁,农民。因心悸、气促、咳嗽3月余,加重3天于1990年4月24日入院。患者近3月来不明原因的出现心悸、气促、咳嗽,有时出现阵发性夜间呼吸困难。近3天来上述症状加重,不能平卧,腹胀,下肢浮肿,尿少。查体:T36.8℃,P104次/分,BP23/11KPa神清,端坐位,颈静脉充盈,双肺底部闻及少许小水泡音,心尖搏动弥散,未触及震颤,心界略向左下扩大,心音低钝,心律整,心率104次/分,肝肋下3cm,肝颈回流征阳性,心电图窦性心律,左室肥厚劳损,胸透,左心缘饱满。WBC11×l0~9/L,PC94×10~4/L,Hb75g/L,尿蛋白(++),RBC(2～3)、WBC(2～3)HP,肝功正常,腹部B超,少量腹水,肝、胆、脾、胰未见异常,入院初诊:扩张型心肌病,给予静脉输入极化液及强心剂尿行血管等药物治疗未见好转,2天后出现嗜睡,呼吸深大,尿量少。
Chronic renal failure uremia, due to multiple organ involvement, and often the onset of other system symptoms caused misdiagnosis. Recently, our department had a case of heart disease onset and misdiagnosed as dilated cardiomyopathy, are as follows. Huamou, male, 54 years old, farmer. Due to heart palpitations, shortness of breath, cough more than 3 months, increased 3 days in April 24, 1990 admission. Patients with unexplained palpitations, shortness of breath, cough, and sometimes paroxysmal nocturnal dyspnea. The past three days to increase the above symptoms, not supine, abdominal distension, lower extremity edema, oliguria. Examination: T36.8 ℃, P104 times / min, BP23 / 11KPa Shen Qing, sitting, filling the jugular vein, the bottom of the lungs smell a little blisters and sound, apex pulsation dispersion, did not touch the tremor, the heart slightly expanded to the lower left , Low heart sound blunt, heart rate, heart rate 104 beats / min, liver ribs 3cm, liver reflux syndrome, ECG sinus rhythm, left ventricular hypertrophy strain, thoracic, left heart margin full. WBC11-3, WBC (2-3) HP, normal liver function, B-ultrasound in the abdomen, WBC11 × l0 ~ 9 / L, PC94 × 10-4 / L, Hb75g / A small amount of ascites, liver, gallbladder, spleen and pancreas no abnormalities, newly diagnosed admissions: dilated cardiomyopathy, intravenous infusion of aphrodisiac and cardiac tarsal blood vessels and other drugs did not improve the treatment, 2 days after drowsiness, deep breathing, urine Less amount.