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急性心肌梗塞(AMI)并发心包炎文献常有报道,临床发生率为7～16%,尸检发生率可达13～45%。但其心包积液量少,未见大量积液者。本文报告三例 AMI 后大量心包积液的误诊。例1 男、49岁,因心前区痛、气促,某医院拟诊“心肌病”。潘生丁、洋地黄治疗无效,1982年8月20日转来我院,ECG、X 线和 UCG 检查提示心包积液,抽出暗红色液体380ml,细胞数756个/μl,比重1.020,粘蛋白测定阳性,诊断“结核性心包炎”。抗痨治疗3天后出现黄疸、肝脏增大、GPT 360u,停止滴注雷米封,改用强的松和保肝药物,5天后心脏大小正常,UCG 探查心前区无液平,ECG 复查提示前壁 AMI,按 AMI 处理后的第8天患者受凉高热,发生急性左心衰,虽采取措施,因咯血量多,血块堵塞气管窒息而死。
Acute myocardial infarction (AMI) complicated with pericarditis literature often reported that the clinical incidence rate of 7 to 16%, the autopsy rate of up to 13 to 45%. However, less pericardial effusion, no large amount of effusion were. This article reports the misdiagnosis of three cases of massive pericardial effusion after AMI. Example 1 Male, 49 years old, because of precordial pain, shortness of breath, a hospital to be diagnosed with “cardiomyopathy.” Dipyridamole, digitalis treatment was invalid, August 20, 1982 transferred to our hospital, ECG, X-ray and UCG examination prompted pericardial effusion, dark red liquid extracted 380ml, the number of cells 756 / μl, the proportion of 1.020, mucin was positive , Diagnosis of “tuberculous pericarditis.” Anti-tuberculosis treatment 3 days after the emergence of jaundice, liver enlargement, GPT 360u, stop drip Remy sealed, switch to prednisone and hepatoprotective drugs, 5 days after the normal heart size, UCG exploration precordial no level, ECG review prompt Anterior wall AMI, AMI-treated patients on the first 8 days of cold heat, acute left heart failure, although measures taken due to the amount of hemoptysis, clot tracheal asphyxia and died.