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病历摘要:男性患者,76岁,石棉厂石棉分类工工龄12年,1962年退休脱离粉尘。63及66年两次X线胸片普查均正常。70年胸片诊断石棉肺Ⅰ期,无症状。以后每年复查胸片,两肺间质性改变有明显进展。73年诊断石棉肺Ⅱ期。74年冬开始咳嗽,气短、心悸、吐泡沫痰。77年诊断石棉肺Ⅲ期。78年咳嗽、气喘、心悸加重,吐粘液脓痰400ml/d,不能平卧,下肢浮肿,于78年6月23日第一次住院。既往于65年有咯血史,67年患过高血压。吸烟50年,10～20支/d。入院检查:体温36.8℃、脉搏82/min、呼吸36/min、血压16/10.7kPa。气管右偏,桶胸,颈静脉充盈,两肺散在哮鸣及中湿罗音。心界不大无杂音,心律不齐。肝肋下1.5cm,剑下4cm,脾未及,腹部有移动性浊音,双下肢轻浮肿,有杵指。心电图示快速型房颤伴完全性右束支传导阻滞、低电压。X线胸片(图1)示双肺弥漫性间质性改变呈
Medical record summary: male patient, 76 years old, asbestos plant asbestos classification workers 12 years of age, 1962 retirement from dust. Both 63 and 66 X-ray findings were normal. 70 years chest X-ray diagnosis of asbestos Ⅰ, asymptomatic. After the annual review of the chest X-ray, interstitial lung interstitial changes have made significant progress. 73 years of diagnosis of asbestosis lung Ⅱ. 74 winter began to cough, shortness of breath, palpitations, spit foam sputum. 77 years of diagnosis of asbestosis lung Ⅲ. 78 years cough, asthma, palpitations increased, spit mucus sputum 400ml / d, can not supine, lower extremity edema, on June 23, 78 first hospitalization. Historically, there was history of hemoptysis in 65 years and hypertension in 67 years. 50 years of smoking, 10 to 20 / d. Admission examination: body temperature 36.8 ℃, pulse 82 / min, breathing 36 / min, blood pressure 16 / 10.7kPa. Right tracheal deviation, barrel chest, jugular vein filling, both lungs scattered in the wheezing and wet rales. Small heart no noise, irregular heartbeat. Under the ribs of liver 1.5cm, 4cm under the sword, the spleen and the abdomen, dullness of the mobile, both lower extremity swollen, with a pestle. ECG rapid atrial fibrillation with complete right bundle branch block, low voltage. X-ray (Figure 1) showed diffuse interstitial lung showed