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目的分析讨论现阶段克山病患者的临床诊断问题,为克山病诊治策略的制定提供临床依据。方法收集慢型克山病自我管理项目组2007年在黑龙江省富裕县调查的53例在册克山病患者的临床资料,包括症状、体征、辅助检查(心电图、超声心动图、胸部X线)结果,并进行描述,对临床诊断进行讨论。结果该病区53例克山病现存患者中,临床症状以头晕、胸闷及活动后心悸、气短最多见(52.83%),其次为心前区不适、咳嗽、胸痛等;体征最多见的为血压高(67.92%)和心脏扩大(45.28%),其次为期前收缩、双下肢水肿等;心电图表现以完全性右束支传导阻滞(52.83%)最多见,其次左室高电压及频发、多源室性早搏等;超声心动图最常见的表现为左心室舒张功能减低(67.92%),其次为瓣膜返流及房、室增大等;43例拍摄胸片者,胸部X线最主要的阳性改变为心影左室段饱满(18.60%)和以左室增大为主的心影中-重度增大(18.60%)。结论该病区相当一部分克山病现存患者(67.92%)存在高血压,是此次临床调查的一个重要发现,给现阶段克山病的临床诊断提出了尚待商榷的新问题。
Objective To analyze and discuss the clinical diagnosis of Keshan disease patients at the present stage and to provide a clinical basis for the establishment of Keshan disease diagnosis and treatment strategies. Methods The clinical data of 53 patients with Chilkshan disease, including symptoms, signs, auxiliary examinations (electrocardiogram, echocardiography and chest X-ray findings) from 53 patients with chronic Keshan disease self-management project in Fuyu County, Heilongjiang Province were collected. , And described, to discuss the clinical diagnosis. Results Among the 53 patients with Keshan disease, the clinical symptoms were dizziness, chest tightness and palpitation after activity. The shortness of breath was the most common (52.83%), followed by precordial discomfort, cough and chest pain. The most common signs were blood pressure (67.92%) and enlargement of the heart (45.28%), followed by anterior contraction and edema of both lower extremities. The ECG showed complete right bundle branch block (52.83%), followed by left ventricular high voltage Multi-source ventricular premature beats, etc .; echocardiography is the most common manifestation of reduced left ventricular diastolic function (67.92%), followed by valvular regurgitation and atrial and ventricular enlargement; 43 cases of chest X-ray, the most important chest X-ray (18.60%) in the left ventricle and moderate to severe (18.60%) in the left ventricle. Conclusions A considerable number of patients with Keshan disease (67.92%) have hypertension in this ward, which is an important finding in this clinical investigation. This is a new question to be discussed at the current stage in the clinical diagnosis of Keshan disease.