从上腹痛患者的心电图 您能看出什么端倪?

2017-04-13 佚名 环球医学

【一般情况】女,73岁,退休,汉族。【主诉】反复上腹痛2年,加重10天。【病史摘要】患者2年前常无明显诱因下出现上腹部疼痛,位于剑突下,呈烧灼样,持续数十分钟,休息后好转,未重视。10天前患者无明显诱因下出现上腹部烧灼样痛,持续1~2小时不等,夜间平躺后明显,发作时伴有心悸、肩部不适、咽喉烧灼感,恶心、欲吐,曾呕吐胃内容物数次,每天发作数次,患者未重视。5小时前患者自觉上述症状加重,休息后无缓解来

【一般情况】

女,73岁,退休,汉族。

【主诉】

反复上腹痛2年,加重10天。

【病史摘要】

患者2年前常无明显诱因下出现上腹部疼痛,位于剑突下,呈烧灼样,持续数十分钟,休息后好转,未重视。10天前患者无明显诱因下出现上腹部烧灼样痛,持续1~2小时不等,夜间平躺后明显,发作时伴有心悸、肩部不适、咽喉烧灼感,恶心、欲吐,曾呕吐胃内容物数次,每天发作数次,患者未重视。5小时前患者自觉上述症状加重,休息后无缓解来急诊,查心电图提示心房颤动,频发室性期前收缩,完全性左束支传导阻滞。患者平日活动量少,有嗳气、打嗝,偶有胸闷,食欲、睡眠差,大小便正常。有高血压病史10余年,平日服用北京降压0号,血压控制情况不详,5年前有胆囊切除手术史。

【查体】

P96次/分,BP136/104mmHg,神清,精神萎靡,推入病房。双肺呼吸音粗糙,未闻及干湿啰音。心浊音界无扩大,心率112次/分,律绝对不齐,第一心音强弱不等,各瓣膜听诊区未闻及病理性杂音。腹软,无压痛、反跳痛,双下肢轻度凹陷性水肿。

【辅助检查】

肌钙蛋白T0.96ng/ml。生化:CK‐MB 24﹒3U/L,LDH611U/L,CK307U/L,AST94.4U/L,血钾3.38mmol/L。心脏彩超:右心房42mm,双房增大,腱索水平以下左心室下壁变薄为5mm,运动幅度减低,左心室下壁所见考虑为心肌梗死所致,左心室收缩功能正常。胸片:双肺纹理增多,主动脉粥样硬化。心电图检查见图5‐28‐1和图5‐28‐2。


图5‐28‐1 急诊心电图:房颤,频发室性期前收缩,完全性左束支传导阻滞


图5‐28‐2 入院心电图:窦性心律,V4~V6导联ST段轻度压低

【初步诊断

冠心病、不稳定型心绞痛?非ST段抬高型心肌梗死?心房颤动、频发室性期前收缩、高血压3级(极高危)、心功能Ⅱ~Ⅲ级。

【诊治过程】

患者入院立即行冠状动脉造影检查,术中见冠状动脉右冠优势,左主干前三叉60%狭窄,前降支及多处病变,最重处75%狭窄,回旋支多处狭窄,最重处85%狭窄,右冠近段闭塞,于右冠球囊扩张植入支架2枚,术后患者上腹部疼痛症状有所改善,术后予抗凝、抗血小板、调脂、稳定斑块、减少心肌耗氧等治疗。

【最终确诊】

冠心病、非ST段抬高型心肌梗死、Killip2级、高血压3级(极高危)、糖尿病前期。

【鉴别诊断

有几种心脏和非心脏情况与非ST段抬高型心肌梗死相似。①慢性基础疾病,如主动脉狭窄或主动脉反流,但其心肌酶谱不会改变。②不同原因的心肌炎、心包炎可有胸痛,并且可有心脏标志物升高、心电图变化和室壁运动障碍,仔细追问病史,最终可以排除。还容易与肺栓塞、主动脉夹层等鉴别,肺栓塞可以查D‐二聚体,CT等可以排除,主动脉夹层CT可以排除。

【相关最新指南及诊治进展】

该患者心绞痛症状不典型,位于剑突下,反复发作,伴有消化道症状,如恶心、呕吐等,易误诊为消化道疾病。该患者首诊即在消化科就诊,查心电图发现完全性左束支传导阻滞,进一步完善心肌标志物检查,发现为急性非ST段抬高型心肌梗死。对老年上腹部疼痛者,心电图出现完全性左束支传导阻滞,不能得知是否既往已有这样的心电图改变,需充分重视,不能忽略急性心肌梗死的可能。

评估患者为非ST段抬高型心肌梗死,确诊后可给予抗血小板双联或者三联治疗,静脉抗凝、抗栓治疗,复查其他生化标志物(如BNP、D‐二聚体)、持续或者重复的ST段监测、缺血危险评估、出血风险评估、抗心绞痛治疗等。对于老年患者和糖尿病患者,应充分评估肾功能,进行出血和缺血风险的评估及高危风险评估。已经证实心脏导管的血管重建能预防再发缺血和(或)改善短期及长期预后。已经发现一些危险因素能预测有创策略的长期获益。按照其风险程度,造影时间分为以下四类:①紧急介入治疗(首诊<120分钟):高危患者,如顽固性心绞痛,强化抗心绞痛治疗后仍反复发作心绞痛伴ST段压低(2mm)或者深T波倒置,临床心力衰竭症状或者血流动力学不稳定,危及生命的心律失常。②早期介入治疗(首诊<24小时):大多数患者最初对抗心绞痛治疗有反应,危险程度高,通过GRACE评估风险评分>140分和(或)存在至少1个高危标准。③介入策略:风险比较低的患者可以在72小时时间窗内行CAG。④保守策略:患者满足以下所有标准可视为低危,不常规接受早期有创评估:无胸痛发作、无心力衰竭、无肌钙蛋白水平升高、无可诱发心肌缺血、最初和第2次(就诊和之后6~9小时)无心电图异常。

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1974314, encodeId=c18b19e43145d, content=<a href='/topic/show?id=199c200660e' target=_blank style='color:#2F92EE;'>#上腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20066, encryptionId=199c200660e, topicName=上腹痛)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Fri Jul 28 23:54:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188087, encodeId=b4a918808ec8, content=好文,值得点赞,更值得收藏!慢慢领会学习的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Apr 17 07:23:02 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272252, encodeId=0e4612e2252b7, content=<a href='/topic/show?id=c01e85565e8' target=_blank style='color:#2F92EE;'>#腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85565, encryptionId=c01e85565e8, topicName=腹痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Sat Apr 15 07:54:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187282, encodeId=409818e28225, content=好文章,大家一起去学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Apr 14 08:04:39 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187218, encodeId=2f1a18e218a2, content=急诊心电图查还是不查, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/AiafG5m7kibldQyTnpaQicxg1rnBqFdIGgQBJJs4lR8ibmh91PibzgL7R7pl2HSBjgFeeKRV0mMCvDh49LrgJPCYYvA/132, createdBy=abc91707732, createdName=qjzhai1623, createdTime=Fri Apr 14 00:11:25 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187156, encodeId=f79318e1567a, content=心脏病以腹痛就诊也不在少数。, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 13 19:01:31 CST 2017, time=2017-04-13, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1974314, encodeId=c18b19e43145d, content=<a href='/topic/show?id=199c200660e' target=_blank style='color:#2F92EE;'>#上腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20066, encryptionId=199c200660e, topicName=上腹痛)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Fri Jul 28 23:54:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188087, encodeId=b4a918808ec8, content=好文,值得点赞,更值得收藏!慢慢领会学习的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Apr 17 07:23:02 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272252, encodeId=0e4612e2252b7, content=<a href='/topic/show?id=c01e85565e8' target=_blank style='color:#2F92EE;'>#腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85565, encryptionId=c01e85565e8, topicName=腹痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Sat Apr 15 07:54:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187282, encodeId=409818e28225, content=好文章,大家一起去学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Apr 14 08:04:39 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187218, encodeId=2f1a18e218a2, content=急诊心电图查还是不查, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/AiafG5m7kibldQyTnpaQicxg1rnBqFdIGgQBJJs4lR8ibmh91PibzgL7R7pl2HSBjgFeeKRV0mMCvDh49LrgJPCYYvA/132, createdBy=abc91707732, createdName=qjzhai1623, createdTime=Fri Apr 14 00:11:25 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187156, encodeId=f79318e1567a, content=心脏病以腹痛就诊也不在少数。, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 13 19:01:31 CST 2017, time=2017-04-13, status=1, ipAttribution=)]
    2017-04-17 ylzr123

    好文,值得点赞,更值得收藏!慢慢领会学习的。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1974314, encodeId=c18b19e43145d, content=<a href='/topic/show?id=199c200660e' target=_blank style='color:#2F92EE;'>#上腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20066, encryptionId=199c200660e, topicName=上腹痛)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Fri Jul 28 23:54:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188087, encodeId=b4a918808ec8, content=好文,值得点赞,更值得收藏!慢慢领会学习的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Apr 17 07:23:02 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272252, encodeId=0e4612e2252b7, content=<a href='/topic/show?id=c01e85565e8' target=_blank style='color:#2F92EE;'>#腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85565, encryptionId=c01e85565e8, topicName=腹痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Sat Apr 15 07:54:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187282, encodeId=409818e28225, content=好文章,大家一起去学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Apr 14 08:04:39 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187218, encodeId=2f1a18e218a2, content=急诊心电图查还是不查, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/AiafG5m7kibldQyTnpaQicxg1rnBqFdIGgQBJJs4lR8ibmh91PibzgL7R7pl2HSBjgFeeKRV0mMCvDh49LrgJPCYYvA/132, createdBy=abc91707732, createdName=qjzhai1623, createdTime=Fri Apr 14 00:11:25 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187156, encodeId=f79318e1567a, content=心脏病以腹痛就诊也不在少数。, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 13 19:01:31 CST 2017, time=2017-04-13, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1974314, encodeId=c18b19e43145d, content=<a href='/topic/show?id=199c200660e' target=_blank style='color:#2F92EE;'>#上腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20066, encryptionId=199c200660e, topicName=上腹痛)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Fri Jul 28 23:54:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188087, encodeId=b4a918808ec8, content=好文,值得点赞,更值得收藏!慢慢领会学习的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Apr 17 07:23:02 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272252, encodeId=0e4612e2252b7, content=<a href='/topic/show?id=c01e85565e8' target=_blank style='color:#2F92EE;'>#腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85565, encryptionId=c01e85565e8, topicName=腹痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Sat Apr 15 07:54:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187282, encodeId=409818e28225, content=好文章,大家一起去学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Apr 14 08:04:39 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187218, encodeId=2f1a18e218a2, content=急诊心电图查还是不查, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/AiafG5m7kibldQyTnpaQicxg1rnBqFdIGgQBJJs4lR8ibmh91PibzgL7R7pl2HSBjgFeeKRV0mMCvDh49LrgJPCYYvA/132, createdBy=abc91707732, createdName=qjzhai1623, createdTime=Fri Apr 14 00:11:25 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187156, encodeId=f79318e1567a, content=心脏病以腹痛就诊也不在少数。, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 13 19:01:31 CST 2017, time=2017-04-13, status=1, ipAttribution=)]
    2017-04-14 大爰

    好文章,大家一起去学习!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1974314, encodeId=c18b19e43145d, content=<a href='/topic/show?id=199c200660e' target=_blank style='color:#2F92EE;'>#上腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20066, encryptionId=199c200660e, topicName=上腹痛)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Fri Jul 28 23:54:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188087, encodeId=b4a918808ec8, content=好文,值得点赞,更值得收藏!慢慢领会学习的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Apr 17 07:23:02 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272252, encodeId=0e4612e2252b7, content=<a href='/topic/show?id=c01e85565e8' target=_blank style='color:#2F92EE;'>#腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85565, encryptionId=c01e85565e8, topicName=腹痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Sat Apr 15 07:54:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187282, encodeId=409818e28225, content=好文章,大家一起去学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Apr 14 08:04:39 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187218, encodeId=2f1a18e218a2, content=急诊心电图查还是不查, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/AiafG5m7kibldQyTnpaQicxg1rnBqFdIGgQBJJs4lR8ibmh91PibzgL7R7pl2HSBjgFeeKRV0mMCvDh49LrgJPCYYvA/132, createdBy=abc91707732, createdName=qjzhai1623, createdTime=Fri Apr 14 00:11:25 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187156, encodeId=f79318e1567a, content=心脏病以腹痛就诊也不在少数。, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 13 19:01:31 CST 2017, time=2017-04-13, status=1, ipAttribution=)]
    2017-04-14 qjzhai1623

    急诊心电图查还是不查

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1974314, encodeId=c18b19e43145d, content=<a href='/topic/show?id=199c200660e' target=_blank style='color:#2F92EE;'>#上腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20066, encryptionId=199c200660e, topicName=上腹痛)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Fri Jul 28 23:54:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188087, encodeId=b4a918808ec8, content=好文,值得点赞,更值得收藏!慢慢领会学习的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Apr 17 07:23:02 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272252, encodeId=0e4612e2252b7, content=<a href='/topic/show?id=c01e85565e8' target=_blank style='color:#2F92EE;'>#腹痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85565, encryptionId=c01e85565e8, topicName=腹痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4aa106, createdName=crystal0562, createdTime=Sat Apr 15 07:54:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187282, encodeId=409818e28225, content=好文章,大家一起去学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Apr 14 08:04:39 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187218, encodeId=2f1a18e218a2, content=急诊心电图查还是不查, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/AiafG5m7kibldQyTnpaQicxg1rnBqFdIGgQBJJs4lR8ibmh91PibzgL7R7pl2HSBjgFeeKRV0mMCvDh49LrgJPCYYvA/132, createdBy=abc91707732, createdName=qjzhai1623, createdTime=Fri Apr 14 00:11:25 CST 2017, time=2017-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=187156, encodeId=f79318e1567a, content=心脏病以腹痛就诊也不在少数。, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 13 19:01:31 CST 2017, time=2017-04-13, status=1, ipAttribution=)]
    2017-04-13 邓启付

    心脏病以腹痛就诊也不在少数。

    0

相关资讯

NEJM:气肿性膀胱炎——案例报道

患者女,72岁,高脂血症和糖尿病控制不佳,下腹疼痛5天。伴有发热、恶心和呕吐。查体:下腹部压痛。辅助检查:白细胞增多与左移(中性粒细胞计数11,800每立方毫米),C反应蛋白水平升高(24毫克/分升)和血糖升高(735毫克/分升)。X线如图A所示,可见肾脏、输尿管和膀胱,膀胱周围有气体,箭头所指处。腹部CT如图B所示,膀胱壁有气体,双侧肾积水,鹅卵石或串珠样肠壁积气。诊断为:气肿性膀胱炎。治疗:广

突然腹痛进了ICU,结果血黑如墨水!

不按时吃三餐且顿顿有肉的年轻快递小哥,血黑如墨;为了奶水充足而每日喝猪蹄汤的孕妇,血如奶油;他(她)们究竟怎么了?

BMJ:结肠镜检查后出现肠道穿孔-病例报道

CT显示腹部存在游离空气,这是肠穿孔的指标。可以看到近期用于内镜下息肉切除的钛夹,并表明是最有可能的穿孔点。

NEJM:原发性高草酸尿症-案例报道

原发性1型高草酸尿症是一种罕见的常染色体隐性乙醛酸代谢紊乱的遗传疾病,导致复发性尿路结石单独或联合肾钙质沉着。支持治疗措施包括高液体摄入,以及口服枸橼酸钾和维生素B6。随访1年,患者尿草酸水平仍然较高,并且多发肾结石。

BMJ:肠脂垂炎-案例报道

这些发现与肠脂垂炎是一致的。这是一种自限性疾病,是由网膜附件肠脂垂缺血和扭转引起的。需要与阑尾炎进行鉴别诊断,意识到这一点很重要以避免不必要的手术。