《精选》病例分析10个.ppt

Case 4 病史：患者：男，58岁，6AM起床后感到胸闷，30 min后突感胸骨后剧烈压榨性疼痛，8AM急诊入院。 查体：血压75/50 mmHg，意识淡漠，心率65次/min，律整。 辅助检查：血化验心肌酶谱增高；心电图示Ⅲ度房室传导阻滞；冠状动脉造影：右冠状动脉上段85%狭窄，中段78%狭窄。 治疗及病情演变：立即给予阿托品、多巴胺、低分子右旋糖酐等治疗。9AM给予尿激酶静脉溶栓。9:30AM患者出现阵发性心室颤动，立即给予电击除颤，静脉滴注利多卡因，到1PM反复发生室性心动过速、室颤，共计6次。4PM后心律转为窦性，血压平稳，意识清楚。 .......... * 问题： 该病人在静脉溶栓冠脉再通后为何会发生频发室性心律失常？ .......... * 提示： 缺血-再灌注损伤（病因和条件、发病机制） .......... * Case 5 病史：患者，男，40岁，入院前一天解黑便2次。有多年胃溃疡病史。 入院查体：神志淡漠，血压60/40mmHg,脉搏130次/min，脉细而弱，皮肤湿冷。 实验室检查：Hb 90 g/L；动脉血 pH 7.3，PaCO2 30mmHg ,[HCO3_]16mmol/L 。 病情演变及治疗：入院后病人又解黑便1次。给予止血治疗，输液和输血共500ml。病人24h尿量约50ml。 .......... * 问题： 1.该患者发生了什么基本病理过程？依据？ 2.该患者血压为何降低？ 3.患者尿量为什么减少？ 4.该患者应如何治疗？ .......... * Case 6 Ms Li, aged 22 years, a student. Her first visit was on June 17, 2012. She had experienced insomnia for more than half a year, worsening frequently due to tense study. Administration of hypnagogues could relieve her symptoms temporarily, but in recent half a year, her symptoms got worse owing to tense study at the end of term. Administration of hypnagogues did not work well any more and she come to visit our hospital again. .......... * She complained of difficulty in falling asleep at night, being easy to wake even managing to fall asleep, inability to fall asleep again after waking, lassitude, dizziness, tinnitus, irritability and poor memory. Examination showed the rapid pulse. It was diagnosed as insomnia of the type of breakdown of the normal physiological coordination caused by prolonged mental stress. .......... * Questions: Why did the patient suffer from isomnia, and it was gradually worsening? What was the mechanism of the rapid pulse? What was the mechanism responsible for the prolonged mental stress in the patient? .......... * Case 7 病史：风湿性心脏病病史10余年。近3月来出现心慌、胸闷, 伴下肢水肿、腹胀，不能平卧。 查体：重病容，口唇紫绀， 半卧位，血压(110/80mmHg)，颈静脉怒张, 呼吸36次/分, 两肺底可闻湿性罗音。心界向左右两侧扩大, 心率130次/分,心尖部可闻IV级收缩期吹风样及舒张期雷鸣样杂音。肝脏在右肋下6cm可触及，有压痛，腹部有移动性浊音，骶部及下肢明显凹陷性水肿。 .......... * 问题： 1.该患者发生了那些病理生理变化？依据？ 2.该患者为何出现下肢水肿？ 3.患者为什么不能平卧？ 4.该患者应如