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患者男,82岁,左上肺肺泡细胞癌术后2年余,因胸壁转移,胸腔及心包积液,于1997年5月11日入院.患者原有高血压病史20余年.入院检查:嗜睡、反应迟钝,体温36.8℃,血压20/14kPa,左胸壁前有一2cm×2cm质硬肿块,左肺呼吸音低,心率80次/min,可闻及早搏3～4/min,肝脾无肿大,血白细胞30.2×10~9/L,中性0.94,淋巴0.06.实验室检查:血钙1.76mmol/L.(正常值:1.05～1.35mmol/L)、尿总钙2.82mmol/L(正常值:1～1.06mmol/L),尿素氮9.8mmol/L,肌酐1.42mmol/L,放免标记:CFYRA21-1为72.2ng/ml(正常<3.3ng/ml).心电图示:窦性心率,偶发房早,部分ST-T改变,左心导联低电压.给予支持对症治疗.次日22:00时,患者突然感到剧烈胸闷,心前区疼痛,气促,寒战,全身大汗,血压升至25/4kPa,心率96次/min,出现频发的早搏,心电图示:急性前间壁心肌梗塞,左束支传导阻滞,频发房早.心肌酶谱LDH 353μ/L,CPK5.2u/L;AST56μ/L,CK-MB 3u/L(正常值2.4u/L).给予吸氧、扩冠止痛,纠正心律失常等药物治疗,监测血电介质,心电图,并先后给予骨吸收抑制剂(阿可达和骨膦)静脉滴注,患者心前区疼痛减轻,血钙降至1.27mmol/L,半月后心电图ST段恢复正常,呈局灶性心梗,心律转为窦性.但停用骨吸收抑制剂2周后,血钙又升至1.4mmol/L,患者厌食及呕吐,少尿,嗜睡至昏迷,虽?
Male patient, 82 years old, left upper lung alveolar cell carcinoma more than 2 years after surgery, due to chest wall metastasis, chest and pericardial effusion, was admitted to hospital on May 11, 1997. The patient had more than 20 years of history of hypertension. Admission examination: drowsiness, Unresponsive, body temperature 36.8 °C, blood pressure 20/14kPa, a 2cm × 2cm hard mass in front of the left chest wall, low breath sounds left lung, heart rate 80 beats / min, can be heard and premature beats 3 ~ 4/min, liver and spleen without swelling , White blood cells 30.2 × 10 ~ 9 / L, neutral 0.94, lymph 0.06 laboratory tests: serum calcium 1.76mmol / L. (normal: 1.05 ~ 1.35mmol / L), urinary calcium 2.82mmol / L (normal Values: 1 to 1.06 mmol/L), urea nitrogen 9.8 mmol/L, creatinine 1.42 mmol/L, radioimmunity label: CFYRA21-1 72.2 ng/ml (normal <3.3 ng/ml). ECG graph: sinus rhythm, Incidental room early, part of the ST-T change, left heart leads low voltage. Give support symptomatic treatment. At 22:00 the next day, the patient suddenly felt severe chest tightness, precordial pain, shortness of breath, chills, body sweating, blood pressure Raised to 25/4kPa, heart rate 96 beats/min, frequent premature beats, ECG: acute anteroseptal myocardial infarction, left bundle branch block, frequent room early. Myocardial zymogram LDH 353μ/L, CPK5.2u /L;AST 56μ/L, CK-MB 3u/L (normal value 2.4u/L). Give oxygen and expand crown Pain, correction of drug treatment such as arrhythmia, monitoring of blood media, electrocardiogram, and intravenous infusion of bone resorption inhibitors (Arabine and Phosphatide), which relieved the precordial pain in the patient and reduced blood calcium to 1.27 mmol/L. Half a month later, the ST segment of the electrocardiogram returned to normal, with focal myocardial infarction, and the heart rate changed to sinusoids. However, 2 weeks after the use of bone resorption inhibitors, the serum calcium rose to 1.4 mmol/L. The patient suffered anorexia and vomiting, and had oliguria. Drowsiness to coma, though?