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患者24岁,住院号156678,孕36周临产伴心慌气急入院。患者2年前因心悸、多汗、食欲亢进等症状,经T_3、T_4等项检查,诊断为甲亢。以他巴唑治疗1年余,症状改善。孕后终止治疗。随孕周增加,症状又渐加重,从孕24周起恢复他巴唑治疗,入院前2周再次停药。患者于孕30周开始出现下肢浮肿,血压增高。既往无肾炎、高血压及心脏病病史。入院时检查:T37℃,Bp190/120mmHg,大汗淋漓,呼吸急促。突眼,甲状腺肿大。心率130次/分,心律齐,无杂音。呼吸40次/分,两肺可闻少许干罗音。宫高32cm,腹围95cm,胎心率136次/分,宫缩规律,宫口开大6cm,胎膜已破。眼底检查未见网膜水肿渗出改变。尿蛋白(+++)。心电图示心肌受损。入院半小时,患者烦燥不安、不能平卧,心率达160次/分。随后,患者两肺出现湿罗音,继而咯大量血性泡沫痰,体温升高达39℃。经内科会诊,给予口服甲基硫氧嘧啶0.2、复方碘溶液60滴,肌注利血平1mg、吗啡10mg,静注西地兰0.8mg、速尿40mg,静滴苄胺唑啉20mg等处理,病情渐缓解。入院5小时,宫口开全,行会阴侧切、产钳助产,娩出活婴。产后转内科继续治疗
24-year-old patient, hospital number 156678, 36 weeks pregnant with palpitation urgency hospitalization. Patients 2 years ago due to heart palpitations, sweating, appetite and other symptoms of hyperactivity, the T_3, T_4 other items, diagnosis of hyperthyroidism. With methimazole more than 1 year, the symptoms improved. After termination of treatment. With the increase of gestational age, the symptoms gradually aggravate, resumed from 24 weeks pregnant methimazole treatment, re-withdrawal two weeks before admission. Patients in the first 30 weeks of pregnancy lower extremity edema, increased blood pressure. No past history of nephritis, hypertension and heart disease. Admission examination: T37 ℃, Bp190 / 120mmHg, sweating, shortness of breath. Exophthalmos, goiter. Heart rate 130 beats / min, heart rate Qi, no noise. Breath 40 beats / min, lungs can smell a little dry rales. Palace height 32cm, abdominal circumference 95cm, fetal heart rate 136 beats / min, contractions of the law, cervix open large 6cm, fetal membranes have been broken. Fundus examination showed no omental changes exudate. Urinary protein (+++). ECG shows myocardial damage. Admission for half an hour, the patient irritable, can not lie down, the heart rate of 160 beats / min. Subsequently, the patient appeared wet rales in both lungs, followed by a small amount of bloody foam sputum, body temperature up to 39 ℃. The medical consultation was given oral methylthiouracil 0.2, compound iodine solution 60 drops of intramuscular injection of reserpine 1mg morphine 10mg intravenous cedilanid 0.8mg furosemide 40mg intravenous benzyl amine zoline 20mg and other treatment , The disease gradually relieve. Admission 5 hours, open all the mouth of Miyaguchi, guild of vulva lateral cut, forceps midwifery, delivered a live baby. Post-natal medicine to continue treatment