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患者,男,63岁,因胸骨后疼痛36小时,于2000年12月18日收住我院。其发病于12月17日中午12时。午饭后骑自行车时,突发胸骨后闷痛。伴大汗、恶心,且呕吐1次,持续不缓解。在当地医院就诊。心电图示,广泛前壁心肌梗死,频发室早。心肌酶:CPK 170u/L,CKMB 22u/L,LDH 172u/L,AST 20u/L,肌钙蛋白阴性。查体:心前区未闻及杂音。入院后,当地医院予以利多卡因50mg静推,尿激酶139万u静滴后,肝素静滴,并予以1-6二磷酸果糖、参麦等治疗。溶栓后,心电图STv_1-v_6弓背抬高均下降50%,但心肌酶峰未提前,胸痛、胸闷未减轻。于第2天,也就是心梗后20小时,心尖部可闻及Ⅵ级粗糙的收缩期杂音且气短,呼吸困难,须高枕卧位。急转我院。入院后查体:BP 135/75mmHg,急性病容,面色苍白,冷汗,两肺底闻及细湿罗音,
The patient, male, 63 years old, was admitted to our hospital on December 18, 2000 because of 36 hours of post-sternal pain. Its incidence on December 17 at 12 noon. When riding a bike after lunch, sudden pain in the sternum. With sweat, nausea, and vomiting 1, continuing not to ease. Visit a local hospital. ECG, extensive anterior myocardial infarction, frequent room early. Myocardial enzymes: CPK 170u / L, CKMB 22u / L, LDH 172u / L, AST 20u / L, troponin negative. Physical examination: precordial area did not smell and noise. After admission, the local hospital to lidocaine 50mg static push, uricase 1390000 u intravenous infusion of heparin, and to fructose 1-6 diphosphate, Shenmai and other treatment. Thrombolysis, STv_1-v_6 ECG decreased bow 50%, but not in advance myocardial enzyme peak, chest pain, chest tightness did not reduce. On the second day, which is 20 hours after myocardial infarction, the apex can be heard and Ⅵ level rough systolic murmur and shortness of breath, difficulty breathing, high occipital position. Sharply to our hospital. After admission, physical examination: BP 135 / 75mmHg, acute disease, pale, cold sweat, both lungs smell and fine wet rales,