病例193:48岁女性反复肺栓塞1例
Chinese Journal of Hypertension（2018）
Abstract
患者,女,48岁,既往体健,因“突发胸闷、呼吸困难4h”于201 5年6月入成都中医药大学附属医院(我院)胸痛中心;急诊科快速床旁检验示心肌酶及心肌损伤标志物阴性,D-二聚体＞10(参考值＜0.5)mg/L;动脉血气分析示pH 7.084,二氧化碳分压(partial pressureof carbon dioxide,PCO2)41.5 mm Hg(1 mm Hg=0.133 kPa),氧分压(partial pressure of oxygen,PO2)63.5 mm Hg,碱剩余-17.2 mmol/L.心电图示窦性心律,V2～V5导联T波深倒置(图1).因患者辅助检查不符合急性冠状动脉综合征表现,且家属拒绝行侵入性检查,故收入心内科重症监护室(cardiac care unit,CCU).入院后查体示血压90/55 mm Hg,床旁超声心动图示肺动脉增宽(28 mm),右心房(57 mm)及右心室增大(30 mm),三尖瓣中量反流,估测肺动脉收缩压约61 mm Hg(图2);肺动脉增强CT示双下肺动脉、右肺下叶内侧基底段动脉充盈缺损(图3).
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