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例1,男,63岁。误把“咯血”当“呕血”。突然“呕血”,以胃出血抢救,效不佳来诊。食欲减退、上腹胀满。“心口”有一硬块。体检发现桶状胸、两肺底有少量小水泡音;心脏向两侧扩大、各瓣膜皆有(SM收缩期杂音)2～3/6级,吹风样,传导不明显;肝剑突下6cm、肋下3cm,下肢轻度凹陷性水肿,颈静脉充盈。肝颈静脉回流征阳性。追问病史,呕出物浅红色、无食物、有泡沫。并有慢支病史。诊断:慢支、肺气肿、肺心病、心衰、心功Ⅲ级。给地高辛0.25mg,第一天qd,第二天Bid,以后每天qd;氨茶碱0.1,双氢克尿塞25mg,氯化钾0.9。三天后症状明显减轻。此例误诊是询问病史不详所致。
Example 1, male, 63 years old. Wrong to “hemoptysis” when “vomiting blood.” Suddenly “hematemesis” to the rescue of gastric bleeding, poor efficacy to the clinic. Loss of appetite, abdominal fullness. “Heart” has a lump. Physical examination found a barrel chest, a small amount of small blisters at both ends of the lungs; heart to both sides to expand, all valves have (SM systolic murmur) 2 ~ 3/6, hair style, conduction is not obvious; , Ribs 3cm, lower limb pitting edema, filling the jugular vein. Positive hepatic jugular vein reflux sign. Question history, vomit light red, no food, a bubble. And chronic bronchitis history. Diagnosis: chronic bronchitis, emphysema, pulmonary heart disease, heart failure, heart function Ⅲ. To digoxin 0.25mg, the first day of qd, the next day Bid, qd after each day; aminophylline 0.1, 25mg hydrochlorothiazide, potassium chloride 0.9. Three days after the symptoms were significantly reduced. This case misdiagnosis is due to unknown history.