论文部分内容阅读
男60岁。自1980年10月起双侧膝、肩、腕及指(趾)关节出现对称性游走性肿痛。一年前曾因左上腹不适及胸闷、心悸、浮肿来院求治.当时检查心包积液,心尖及心底部有杂音,脾肿大,双手指关节轻度肿胀,白细胞及血小板显著减少。拟诊“风湿性心脏病,脾肿原因待查”收入院,经强心、利尿和对症治疗2个月好转出院。本次因上述病情加重5天再次入院。既往无结核、肝炎、疟疾、黑热病等病史。体检:体温、脉搏、呼吸均正常,血压17/8kPa,神志清、贫血貌。右肘关节尺侧可触及2枚黄豆大之皮下结节。心界向两侧扩大,偶闻及早搏,心尖部有较柔和的双期杂音,主动脉瓣区有Ⅳ～Ⅴ级收缩期喷射性杂音并伴有震颤,杂音向右颈部传导。两肺正常。腹软,肝右肋下2cm,边缘钝,质中等硬,无触痛。脾下缘平脐,右缘越正中线1cm,质硬,表面光滑,无结节。双下肢轻度凹陷性水肿。
Male 60 years old. Since October 1980 on both sides of the knee, shoulder, wrist and finger (toe) joints symmetrical migratory swelling and pain. A year ago because of left upper quadrant discomfort and chest tightness, palpitations, edema to the hospital for treatment .At that time to check the pericardial effusion, apical and heart murmur, splenomegaly, mild swelling of both hands and joints, leukocytes and platelets significantly reduced. The proposed diagnosis of “rheumatic heart disease, spleen etiology to be investigated” income hospital, cardiac, diuretic and symptomatic treatment improved 2 months were discharged. This time because of the above illness aggravated 5 days again hospitalized. No previous history of tuberculosis, hepatitis, malaria, kala-azar. Physical examination: body temperature, pulse, breathing are normal, blood pressure 17 / 8kPa, clear consciousness, anemia appearance. Right elbow ulnar side can reach 2 large subcutaneous nodules of soybeans. Heart bound to both sides of the expansion, anecdote and premature beats, apical softer biphasic murmur, aortic valve area Ⅳ ~ Ⅴ systolic jet murmur accompanied by tremor, murmurs conduction to the right neck. Normal lungs. Abdominal soft, right ribs 2cm liver, blunt edge, medium hard, no tenderness. The lower edge of the spleen flat navel, the more right midline 1cm, hard, smooth surface, no nodules. Lower limbs slightly depressed edema.